Welcome to

Central Florida Samoyed Rescue, Inc.

Adoption Application

Home page of Central Florida Samoyed Rescue
Here you'll find information about the Samoyeds we currently have in our rescue program.
Take a look at some of our previous Sams and read their stories!
If you are interested in adopting a rescue Samoyed please fill out our adoption application.
Central Florida Samoyed rescue is always in need of foster homes. If you think you might like to foster a Samoyed waiting for a new home please fill out our foster application.
There are many areas where rescue needs help other than fostering. Some don't require that you have any previous Samoyed experience. Please take a look at our volunteer application if you would like to help us help Samoyeds in need.
If you have any questions please contact us.

The most successful adoptions are created by matching the right dog with its best possible household. Please answer ALL of the following questions to assist us in finding the dog most suited to you. (We reserve the right to refuse an applicant.)

Thank you.

(CFSR = Central Florida Samoyed Rescue)

Please note: Our volunteers are concentrated in the Central Florida (Orlando/Tampa) area. By completing this application, you agree to meet with a CFSR representative and to take possession of a rescue Samoyed (if approved for adoption) within CFSR's normal area of operation.


Personal Information
First Name
Last Name
Address
City
State
Zip
-
Home Phone
- -
Work Phone
- - ext.
E-mail
Best time/method to contact you

Housing Information
What is you current housing status?
Rent Own
If renting, is the landlord agreeable to dog ownership?
Yes No
If renting, are you able to supply a copy of the renter's policy or written permission on pet ownership?
Yes No
Which of the following best describes your current type of home?
Apartment/Condo
Townhome
Single family home
Other
Is your yard currently fenced?
Yes No
If yes, please describe the type of fencing.
Do you padlock your gates (if applicable)?
Yes No

Family Information
How many adults are living in the household?
Please answer the following for each adult.
Name Age range Occupation How long Employed?
Adult 1
Adult 2
Adult 3
Adult 4
Are there or are you planning to have children living in the household?
Yes No
If yes, how many children (please include both current and planned)?
Please list the specific ages of current children
Are there other adults or children who visit your home on a regular basis?
Yes No
Please provide additional information regarding your regular visitors such as ages and any specific questions or concerns relating to their interaction with a dog.
Does anyone in the house or who visits regularly have any known allergies to or fear of dogs?
Yes No

Pet information
What types of pets are currently living in your household?
Please provide additional information regarding your current pets such as ages and any specific questions or concerns relating to their interactioon with a new dog.
Have you ever owned a dog before?
If yes, please answer the following about current and previous dogs.
Name
Breed/Type
How long did you own it? (Years/months or still have)
What happened to it? (please be specific - died of what or given to whom)
Dog 1
Dog 2
Dog 3
Dog 4
What activities did you do with them?(obedience classes, talking for walks, etc.)
How did you correct or train this (these) dogs?
Are (were) your last dog(s) on heartworn prevention?
Yes No
Would you be willing to supply a copy of veterinary records on this (these) dog(s) and/or allow us to contact your veterinarian?
Yes No
If yes, please provide the following for your current or most recent veterinarian.
Name
Address
City, State, Zip
Phone Number

Desired Characteristics
How did you hear about our Samoyed rescue?
How did you learn about the Samoyed breed?
What is your reason for choosing this breed?
Do you have a gender preference?



What is your reason for this gender preference?
Do you accept that the dog will be neutered or spayed?
Yes No
Do you have a preferred age?

None
0 - 2 years
3 - 5 years
6+ years

Reason for this age preference?
Many older dogs make wonderful companions and have great manners. Please consider one. Younger dogs do also require a lot more work.
Would you consider adopting an older dog?
Yes No
Does the entire family want this dog?
Yes No
Have you ever previously applied for or adopted a dog from rescue?
Yes No
If yes, what were the rescue group's name and the dog's name at time of adoption (if applicable)?

Samoyed Characteristics
Samoyeds are primarily a herding and sledding breed. As such, they can be runners, barkers, diggers, chewers, and usually have a tendency to pull on lead. They are also a double-coated breed which requires a lot of grooming time.
Are you aware of and prepared to handle the characteristics of the breed.
Yes No

Responsibility
Who will be primarily responsible for taking care of the dog? (Feeding, walking, grooming, etc.)
Would you be willing to take this dog to obedience classes (if needed)?
Yes No
Are you willing to house break a puppy?
Yes No
If yes, what is your method of house breaking?
Do you own a crate to house the dog while unattended?
Yes No
Where will the dog be primarily kept?




How many hours a day would the dog be left alone?
What best describes where the dog will primarily be when left alone (even if only for a short time)?

Inside:








Both:


Long term care
The life expectancy of a Samoyed is 10 -15 years.
Are you willing and prepared to commit to caring for a dog for this length of time?
Yes No
Under what circumstances do you think you might need to return a dog (e.g. moving, job change, change in family status, etc.)
If something happened to you, who would care for this dog?

Budget and Emergency Care
What would you estimate as the normal annual cost of caring for a Samoyed? (include food, heartworn & flea/tick preventative, vaccines, crate, bedding, toys, grooming, etc.)
Will the cost of caring for this dog fit comfortably into your budget?
Yes No
In addition to the normal, everyday care and cost of a dog, emergency situations or special needs may arise.
Would you be able to handle the additional costs of an emergency situation?
Yes No
An average Samoyed weighs 35 to 65 pounds, possibly more.
Would you be able to lift a dog of this size that is unable to walk due to injury or illness (or readily get assistance with lifting)?
Yes No
Would you be able to handle the additional costs and other needs of a dog that has or develops a permanent medical condition?




Florida is the heartworm capital of the world. Heartworms come from mosquitoes biting the dog.
Are you aware of the cost of preventing or treating heartworm?
Yes No

Activities
What are your plans for this dog?
Pet
Obedience
Guard
Therapy
Herding
Other
If other please explain:
Are there other things you might like to try or learn more about or do with your dog? e.g. volunteer to assist Rescue, obedience, agility, weight pull/carting, hiking/backpacking, herding, therapy, grooming, joining national or local Samoyed breed club.

Rescue costs

Rescue is supported by individuals. Some dogs may have extensive medical conditions which must be handled before the dog can be placed. As such, CFSR requests a donation of $300.00 to help offset these costs.

Are you agreeable to this?
Yes No

Behavior Agreement
Some of these dogs may have histories of abuse or neglect. If accepted, you will be required to sign an Adoption Agreement, which recommends that the adopted dog be watched initially for signs of destructive behavior or aggression. CFSR will not knowingly place an aggressive dog. If this behavior is noticed, there are steps to take such as verbal and physical praise but only verbal disapproval, etc.
Do you agree to isolate or otherwise handle any destructive/aggressive behavior appropriately without the use of physical discipline?
Yes No

Final comments

Can you please tell us a little about yourself and your family? (Your home, job, hobbies and interests, etc.)

Do you have any questions or comments?


I understand that a dog can be unpredictable and that CFSR cannot anticipate or insure against unexpected conduct of an adopted dog from CFSR. I acknowledge that CFSR has not made through its volunteers, any warranties regarding the future condition, temperament or conduct of the dog. I hereby agree to accept an adopted dog as is, assume all risks and responsibilities associated with adopting this dog, including bites, and I hereby fully and completely release, indemnify, and hold harmless CFSR, its directors, volunteers and agents from any claim, cause of action or liability of any sort or nature, whether, known or unknown, directly arising out of or in connection with the ownership, care, maintenance, retention, temperament, conduct or condition of the dog.

CFSR will never knowingly place an ill, injured or poorly socialized dog in an adoptive home without first apprising the adoptive family of the situation. Thank you for your application.

To the best of my knowledge the foregoing information is true and I have read and understand the above disclosure.
I agree
Date:
Signature:

 

If you have further questions, please contact us. Please note that on-line applications and email inquiries are preferred when possible.


 

CENTRAL FLORIDA SAMOYED RESCUE, INC. IS A REGISTERED NON-PROFIT CORPORATION IN THE STATE OF FLORIDA . A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE 1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

100% OF THE CONTRIBUTION OR PROCEEDS WILL GO TO CFSR, INC. FOR THE BENEFIT OF ITS SAMOYED RESCUE PROGRAM REGISTRATION NUMBER CH18840.


Page last updated 11/21/2014