ADOPTION APPLICATION

  • Adoption fees range from $250-$500.
  • Adoption contracts must be completed and approved.
  • Home visits can be required.
Name *
Name
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Why are you considering adopting a dog? *
Where would the animal be primarily housed? *
Where would the animal stay when you are not home? *
Type *
Sex *
Family Considerations
Renters will be required to provide a copy of your lease agreement that states dogs are allowed, along with breed and size requirements.
Outdoors
Describe your yard *
If not fenced, how will dog be allowed out to eliminate
If the animal is outside other than for supervised activities, describe what shelter would be available for it:
Care of Animal & Home Environment
What problems would make you return an animal? *
To help resolve problems are you willing to: *
Under what other circumstances would you return the animal? *
Describe your home's activity level: *
Type of Animal/Breed, Time Owned, Age, Gender, Neutered/Spayed, Vaccinated, and are they on Heartworm prevention?
Please provide THREE personal references. Be sure to include their name and phone number.
If at any time an adopter cannot keep the animal, it must be returned to Yvette Nielsen and/or any other co-owner listed at time of placement. If the animal is not spayed or neutered at adoption, the adopter is required to alter the animal and provide a veterinary certification of altering to Y-not a Sam Rescue by the date specified in the adoption contract -- animals unaltered by the contractual date may be seized. In addition, each pet adoption is assessed a non-refundable tax-deductible donation, varying by animal to help pay veterinary/other expenses. By selecting "yes" below, I acknowledge that I completely read this questionnaire, comprehend it fully, know that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application or the adoption contract can result in the forfeiture of any available/adoptable Samoyed rescued/ adopted by me.