Questionnaire for Potential Puppy Families
As a breeder, I feel an obligation to my puppies, to you as a potential puppy buyer, and to myself and my breeding program. You and your puppy will be entering into a relationship
that should last 12-14 years or longer. The following questions will help me to help you find the right puppy.  The list is rather lengthy, so please fill it out when you and other members
of your household have some time to spend on it together.  

When you are finished, please
print this form so you can sign and scan/email or mail it to me.  Thank you!

Have you ever raised a puppy?
If yes, how long ago?
What kind of puppy?
Where did you get it?
If the puppy described above was not a Samoyed, have you ever owned a Samoyed?
If you have owned a Samoyed, where and when did you get it?
What happened to it?
What other dogs, besides your Samoyed(s) have you owned as an adult? Please mention when and where you got the other dogs and what happened to them.
Please describe your perfect dog.
If you have not owned a Samoyed, have you spent any time with Samoyeds?  If yes, how much time?
What have you read and to whom have you spoken about Samoyeds?
Why do you want a Samoyed?
What characteristics of the breed appeal to you?
What concerns do you have about the breed?
How do you feel about a dog that sheds (moderate to heavy shedding most of the year, very heavy in spring and fall)?
Please list all human members of your household and their ages.
If yes, when?
Do you plan to have children in the future?
If you plan to have a child, or more children, in the future, please explain how this will affect your relationship with your dog.
Does any member of your household or frequent visitor have a disability that would affect his or her interaction with a puppy or
active medium-to-large adult dog?
If yes, please explain.
If yes, how do you plan to handle the problem with your new Samoyed?
Is anyone in your household allergic to dogs?
List breeds, ages and gender of other dogs you have now.  If none, enter "none."
List non-canine pets, what kind and ages.  If none, enter "none."
Describe your yard and your fence (size, type, pool? etc.)
How do you plan to exercise your dog?
Please describe (1) where your dog will live (inside, outside, etc.), (2) where he/she will sleep at night, (3) how much time he/she
will spend alone, and (4) where he/she will spend that time alone.
Where will your dog stay if you go out of town?
Please describe your vehicle and where your dog will ride when he/she goes with you.
Are you willing to obtain and use a crate for the comfort and safety of this puppy?
Where do you work or what do you do?
YES    NO       NOT SURE
Can you afford the costs of a puppy that will mature into a large dog (veterinary care, food, toys, training, etc.)?
YES    NO       NOT SURE
Are you willing to learn to groom your Samoyed properly for his/her health, comfort, and appearance?
(I will be happy to guide you.)
Samoyeds are versatile, athletic dogs.  Please describe your plans for this dog (for example, competition,  performance,  
conformation,  breeding, or other activities).  
Are you interested in pursuing, or learning more about, any of the following activities
as a hobby for competition/titling?  Please select one or more activities from the list.
If "other" or "none" please provide more information about your selection.
Might you be willing to (1) learn to show your dog if it is a show quality puppy, or (2) have the dog shown by someone else?
Also, please describe you prior experience, if any, in showing dogs in conformation, or how you might prepare yourself and your
puppy/dog to compete successfully.  (I will be happy to guide you.)
If you are interested in training for performance events (obedience/rally, agility, etc.), (1) please describe your experience in the
area(s) of interest, or (2) if you are inexperienced, please provide information about how you will prepare yourself and your
puppy/dog to compete successfully. (I will be happy to guide you.)
What dog-related organizations do you belong to or support?
If you do not already belong to the Samoyed Club of America and/or your local kennel club, would you be interested in joining?
Have you ever bred dogs or
other animals?  
If yes, please describe your activity and experiences as a breeder.
Please rank the following factors in order of importance to you in your choice of a puppy (1 = most important; 5 = least important):
Potential as a
show dog
Potential as a performance dog
Any other priority factors:
Where did you learn about me or my litter/puppy?
Please provide names, addresses, phone #'s and email addresses of 3 non-family references, preferably people who know of your dog-owning history or interest in dogs.
A veterinarian and/or obedience instructor, or breeder, is ideal.
After completing and printing this form, please initial your understanding of the following statements and your agreement with these statements:

______As the breeder, I have an intimate knowledge of each puppy in my litters based on at least 8 weeks of close observation. As a buyer, your opportunities to observe the
puppies are rather limited. Knowing this, you are willing to let me select for you the puppy (or puppies among which you may choose) best suited to your expressed needs.

______If there is no puppy in the litter that appears to be suited to your particular needs, lifestyle and priorities, then I will not sell you a puppy from this litter.  If I do not have a puppy
for you I will be happy to refer you to other breeders who might be able to help you.  In other words, first come is not necessarily first served because it is of utmost importance to me
that you and your puppy are a good match.

New guidelines for spaying and neutering recommend careful consideration of the negative health impacts in dogs under two years old.

______If you are buying a potential show/breeding dog, you will not be permitted to breed him/her until the dog is two years old and completed the breed required testing for CHIC
(Caninie Health Information Center) including being found non-dysplastic by OFA and has a clear or breeder option OFA eye exam at 2 years old.  E
ye (and possibly heart)
clearances are required annually for dogs that will be bred.  Breeding decisions must follow the Samoyed Club of America Code of Ethics.
Do you have any other questions or concerns about your potential purchase of a Galaxy Samoyed?
After completing this form, please PRINT it.   Then have each adult in your household, in the space below, print and sign their name and add the date.  Please mail or scan and email
the completed and signed form to me.

Feel free to call or e-mail me — and you are welcome to visit before the puppies arrive. (Visits after the puppies arrive are restricted during the first 5 weeks due to dangers of
disease.)  We would like to meet you, and we would like you to meet our dogs to be certain that this is the breed for you, and that our style of Samoyeds are what you are looking for.

Thank you for taking the time to complete this questionnaire, and for your interest in a Galaxy Samoyed!

Diane Dotson
Galaxy Samoyeds
P.O. Box 4224
Abilene, TX 79608                 Email            Phone 325-725-5536