Puppy Application

Thank you for your interest in Rapture Samoyeds. We appreciate your interest and to help us know you better and pick the right puppy for you, please take a few minutes to complete the following questionnaire.

All information is strictly confidential and will only be used by myself to help ensure a place on my waiting list.





Home Phone


Work/Cell Phone

Website URL


How long have you lived at this address?

Type of dwelling?

If renting, do you know if your landlord allows this specific breed?

If you answered "No" or "I'm not sure" would you be willing to provide your landlords information to me?

What is your occupation? Your spouse's (if applicable)?

Referred By:

Name, address, and phone number of your veterinarian

May I contact your veterinarian as a reference?

Please list names and contact information for two personal references (not related) that you have know for at least (2) years

Who will be the primary care giver?

Where will the puppy be kept during the night?

Where will the puppy be kept during the day?

Is anyone home during the day?:

How many hours on the average will the puppy be left alone?

Will there be someone available to feed and excercise the puppy during the day?

Have you ever owned a dog before?

Do you have any other animals?

Do you have any children?

If yes, what are their ages?

Does anyone in your household have allergies to animals?

If yes, to what and how severe?

Are you interested in a male or female puppy?

At what age do you wish to get the puppy?

Have you considered an older dog instead of a puppy?

How did you hear about this breed?

How many individuals of this breed are you acquainted with?

What do you expect the activity level of this breed to be?

A Samoyed's double coat will need regular grooming to be kept mat free, are you ready and willing to perform frequent grooming? Or will you have a groomer do it?

Have you researched the Samoyed breed and feel its characteristics suit you?

What kind of floor surfaces will the dog be on in the house?

How many hours a day will the puppy be kept outside?:

How will he be confined when he is outside?

Do you have a fenced yard?

If no, are you willing to fence your yard?

Have you ever house trained a dog before?

Will you be attending any training classes?

If yes, at what age will you start, which activities or competitions are you interested in, who is the trainer?

How long did you last pet live? What were the circumstances of it's death?

Have you ever returned a pet to the breeder? If so, what were the circumstances?

Have you ever given a pet away? If so, what were the circumstances?

Have you ever taken a pet to a pound or shelter? If so, what were the circumstances?

Are you interested in showing the dog in the conformation ring?

Have you ever shown a dog to it's championship?

Are you interested in performance events such as obedience, agility, hunting, herding, etc.? Which events?

Have you acquired any performance titles on a dog before? If so which?

Do you intend to breed the dog?

Do you understand the difference between a limited registration and a full registration?

Please tell us why you think you would be a good home for a Rapture Samoyed.

Please add anything else you would want the breeder (me) to know.