FIRST TIME OWNERS PUPPY QUESTIONNAIRE We appreciate your taking the time to complete and return the following questionnaire. Detailed information regarding your lifestyle and experience with dogs helps us in selecting the right puppy for you and your family. Please print out and fill in the below form. An online form with submission abilities is under construction. Name(s): _______________________________________________________________________________ Street Address: __________________________________________________________________________ Mailing Address: ______________________________________________City: ______________________ State: ___ Zip Code: ______________ Phone: (H) _____________________________ (W)____________ Fax: (H) ______________ (W) ___________________E-Mail: (H) ________________ (W) ____________ What do you know about Samoyeds and what attracts you to the breed? How much time can you spend grooming a Samoyed? Have you ever owned a dog before? Yes_____No_____Breed(s) What happened to them? Do the other members of your family also want to get a puppy? What other types of animals live in your house? Have you ever had a dog that died or had a significant health issue? Have you ever had to put an animal to sleep? If yes, why? What is the most important reason(s) for purchasing a Samoyed (check all that apply):  family companion ___ show dog ___ breeding _____ obedience competition ____ agility / fly ball competition____ pet therapy_____ a dog for the kids ____other____________ Have you taken obedience or puppy kindergarten classes with a puppy/dog before? Where? Do you prefer a male or female puppy/dog? Are you willing to spay/neuter this puppy? If you move, what will happen to this puppy/dog? Do you believe in using dog crates? Yes ___ No____ Why? Do you have any objections to a home check by us or by a person we designate? Yes___ No___ How will you feed this puppy/dog? Free Choice Once a Day Twice A Day Family Profile: Please circle: Married Single Divorced Separated Widowed Live w/ parent or relative Live w/ other How long? years months Do you have plans to move soon? Your age: Occupation Spouse/Partner’s age: Occupation Who will get this dog in case of divorce or breakup of relationship? Number of children in household and/or who visit on a regular basis: Ages: Have these kids been exposed to dogs before? Explain. If you don't currently have children, are you planning to start a family in the future? Please circle the type of area you live in: City Suburb Subdivision Country Are there covenants, ordinances or other restrictions regarding dogs in your area? If yes, explain. Will the puppy/dog be kept: Inside____Outside____In yard____Loose____Kennel Run______ Garage_____ Basement____Other__________________________________________________ Is your yard fenced? Yes____No____ Fence type and height_______________________________ If you do not have a fenced yard, where and how will the dog be exercised and be allowed to eliminate? Do you have a swimming pool? If yes, it is fenced in? Does your home have air conditioning? Basement? Cool garage? Other Do you have a deck? How high off of the ground is it? Railing? Would you object to sending photos of your home and property? If you rent, do you have written permission from your landlord to have a medium size dog? Would you mind if we contact your landlord? Name: ______________________________________________________________________ Address: ______________________________________________ Phone: ___________________ Where will the puppy/dog sleep at night? Where will the puppy/dog be kept when there is no one at home? How many hours each day will your puppy be alone while you are at work? Who will have the major responsibility to care for your puppy/dog? What will you do if the puppy/dog barks excessively? How much money do you expect to pay for veterinary care each year? Do you have a current veterinarian? Name/Business Name: __________________________________________________________ Address: _______________________________________________________________________ City: __________________________________ State: ____ Phone:_________________________ Please list one personal reference and one work reference: Name: ______________________________________________________________________________ Address: ____________________________________________________________________________ City/State ________________________________ Phone: __________________________________ E-mail: _____________________________________ Years Known: _____________________________ Name: ______________________________________________________________________________ Address: ____________________________________________________________________________ City/State ________________________________ Phone: __________________________________ E-mail: _____________________________________ Years Known: _____________________________ Please add other information that would be helpful in placing a puppy with you: Thank you for your interest in White Magic Samoyeds.