Puppy Buyer Questionnaire

Shirokuma Samoyeds
Ann Marie Schroeder
615-756-1132

The following questions will help me to determine if a Samoyed puppy is the right fit for you and
your family. Do the best you can in answering the questions - there are no right or wrong answers.
Please return all 5 pages. This questionnaire will be used to assist you further with raising and
training your new puppy. My goal is a happy home for both puppy and family for a lifetime. Feel
free to use an additional sheet of paper if necessary. Thank you!

Name​:_________________________________ ​E-mail Address​:______________________________

Address​:_____________________________________________________________________________
Day Phone​:_____________________________ E
​ vening Phone​:_____________________________

Family Information
1) How many adults live in your home? __________
2) Do you have any children? _____ Ages of children in the home: __________________________
3) What activities do you enjoy in your spare time? _______________________________________
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4) Do any family members have concerns about getting a puppy? __________ List concerns:
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5) Do any family members have allergies to dogs? _______________________________________
6) Who will be the primary caregiver for your puppy? ____________________________________
7) Please list other dogs owned, the breed, and why they are no longer with you:
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8) Have you ever given up a dog to a shelter or rescue group? _______ Have you ever returned a
dog to the breeder? _______ Explain: _________________________________________________
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9) What problems (health, behavior, training, ect.) have you had with previous dogs?
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10) Have you completed any AKC/CKC/UKC titles on other dogs? _________ If yes, describe
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11) Have you bred a dog before? _______ If yes, explain __________________________________
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12) If your family circumstances change (new baby, change of residence or job, ect.), what will
happen to the dog? ________________________________________________________________
13) Do you currently own any other pets? ___________ If so, please list Type/Breed/Age :
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14) Do you have a veterinarian? _____ If so, please provide name, address, and phone number.
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15) Would you be willing to vaccinate yearly, use preventative treatment for heartworm, flea&ticks?
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16) Please provide 3 references that can verify the suitability of your home for a Samoyed puppy.
Name: ________________________________________ Phone# ___________________________
Name: ________________________________________ Phone# ___________________________
Name: ________________________________________ Phone# ___________________________
17) Please give any additional information that will help us get to know you, your family, your
needs with respect to placing a puppy most suited to your family: ___________________________
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Housing Information
1) Do you live in a house / apartment / condo / townhouse? _______________________________
2) If renting, do you have your landlord’s permission to have a dog? _____ Please list name and
phone number: ____________________________________________________________________
3) Do you have a yard? ______ If Yes describe your yard (fenced-type/height, size, grass or
concrete, trees, ect.) _______________________________________________________________
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4) Do you have a swimming pool? _______ Is it fenced? __________________________________
5) How do you plan to exercise your dog? ______________________________________________
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6) Please describe the area where your puppy will be living and sleeping: ____________________
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7) Is a family member home throughout the day? _________ If not, what are your plans for
mid-day care for your puppy?
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Puppy Information
1) Have you ever owned a Samoyed before? ____________________________________________
2) Why do you want to own a Samoyed? What specific traits attracted you to this breed of dog?
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3) Have you researched the breed thoroughly to determine if this is the right breed for you? _____
4) Are you aware of health problems that may affect a Samoyed? ___________________________

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5) Are you aware that Samoyeds are potentially barkers, diggers, and chewers …especially if left
alone for extended periods of time?
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6) Samoyeds periodically shed and require grooming, will this be an issue?
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7) How do you plan to keep your Samoyed groomed? _____________________________________
8) Have you ever raised a puppy before? ______ How long ago? ____________________________
9) Where will your puppy/dog primarily spend its time? ___________________________________
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10) Where will the puppy sleep at night (i.e. loose in the house, crated, kennel run, yard, confined
to a specific room)? ________________________________________________________________
11) Where will the puppy/dog be housed when no one is home? (i.e. loose in the house, crated,
kennel run, yard, confined to a specific room)? __________________________________________
12) How many hours will the puppy be left alone? ________________________________________
13) Where will your puppy/dog stay if you go out of town? _________________________________
14) Have you thought about how you will house break your new puppy? _____________________
Describe plan: ____________________________________________________________________
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15) Do you plan to crate-train your puppy? _____________________________________________
16) Puppies require A LOT of socialization while young, what are your plans to provide this?
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The NUMBER ONE reason dogs find themselves homeless is because of behavior problems…
17) Are you willing to enroll and complete a puppy class / obedience classes? _______
If “no” please explain why not, and your plans to train your puppy __________________________
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18) Do you prefer male – female – either and why? ______________________________________
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19) Tell us what you’re looking for in a Samoyed? (personality, temperament, activity level, ect.)
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20) What are your plans for your puppy/dog? (i.e. Conformation, Obedience, Agility, Rally, Herding,
Tracking, Sledding/Weight Pull, Therapy Work, Companion/Best Friend, ect.) __________________
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21) If this is a show puppy, will you be showing it yourself or will you be hiring someone to show
for you? _________________________________________________________________________
22) Please rank the following factors in order of importance in your choice of a puppy
(1,2,3,ect…with 1 being most important)
Structure ________
Health History_______
Temperament ________
Appearance ________
Sex of puppy ________
Potential Obedience/Agility Dog ________
Family Companion ________
Potential Show Dog ________
Potential Breeding ________
Sledding/Weight Pull ________
Pet Therapy ________
Search & Rescue ________
Other ___________________________
23) If this puppy is purchased as a family companion and not to be bred, do you understand to
have it spayed/neutered NOT PRIOR to 24 months (we do not support spay/neuter at a young age
due to health issues)? _________
24) Are you willing to follow the Breeder’s recommendations?
- for proper feeding (Raw diet or high quality kibble/can) _________________________________

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25) The puppy must be registered with AKC and carry our kennel name, is this a problem?
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26) Are you willing to stay in contact with the Breeder for the life of the dog and provide updates
(health, testing, accomplishments, pictures!, ect)? _________________________________
27) Do you understand that you may ​Never sell or re-home a puppy from Shirokuma Samoyeds​, if
you cannot keep him/her for ANY reason during it’s entire lifetime, it ​MUST​ come back to me.
Do you have any objections to this? ___________________________________________________

DEPOSIT INFORMATION
A deposit is an agreement to purchase a puppy from a particular litter provided a puppy of the
desired sex is available. If such a puppy is not available, the deposit will be refunded in full. If a
puppy of the desired sex is available, but the buyer chooses not to finalize the purchase, the
deposit is not refundable. We reserve the right not to sell to a particular buyer if there is any
question about the buyer’s ability to properly care for the puppy. In this case the deposit will be
refunded. Deposit amount is half the purchase price.

Now it’s your turn to ask me questions...

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​____________________________________ Date _______________

Prospective Puppy Buyer Signature