Maria C. Kirylo
PO Box 128
Milwaukee, WI 53201

Thank you for contacting us in your search to adopt a Samoyed! Below is a short questionnaire for you to fill out that will enable our volunteers to learn a little about you and what type of dog you are looking for. PLAYING AGAIN SAMS OF WISCONSIN volunteers all have Samoyeds of our own and love the breed. We know what great companions Samoyeds are and we pride ourselves on striving to make the best match of dog to adoptive family.

The average rescued Samoyed costs our organization $250+ especially if they haven't yet been altered. Since we are a not-for-profit group, we do request a donation of $225 ($275 for dogs less than 12 months old). All of our Samoyeds are neutered, vaccinated, fecal and heartworm tested, microchipped, and groomed prior to placement. Any monies not used directly by the dog that you are adopting goes into a fund to be used on others more needy. We have taken in very sick dogs and dogs injured in accidents requiring surgery or treatment amounting to several hundred dollars.

We are an all-volunteer organization limited by lack of funds and by the number of people able to foster dogs. If you would be interested in fostering or in volunteering in any other capacity, please let us know!

Thank you for your interest and we'll be in touch as soon as we have a dog that we think would be compatible with your family and lifestyle.


Contact Information

Name: Occupation:
Co-applicant's Name: Co-Applicant's occupation:
Address: Email:
Home Phone: Work Phone:


A successful adoption depend on matching the right dog with the right home. So that we may assist you with this selection, please answer the following questions as completely and as honestly as possible.
Do you: Rent? Own? If rent, the landlord's name: and phone number:
House Apartment Duplex Town House Other
Do you have children? Yes No If so, ages?

Have you ever owned a dog before? Yes No Breeds
What happened to them?
Who will be primarily responsible for the dog?
What other types of animals live in your house?

What do you know about Samoyeds and what about the breed attracts you?

Do you have a sex preference? Male Female Either. Why?

Minimum or maximum age preference?

Are you willing to take a dog with medical/handicap problems? Yes No

Which "problems" could you not deal with?
3 legs diabetes
blindness deafness
epilepsy hip dysplasia
senior (8 years old and above)

Do you or anybody else in the household have allergies?
Would you be willing to adopt a samoyed mix? Yes No

In general, how active is your family? Couch potato
Very Active

Is your yard fenced? Yes No Fence type and height

If you do not have a fence, where and how will dog be exercised and allowed to eliminate?

Will the dog primarily be kept:
In Yard
Invisible Fence

Where exactly will the dog sleep at night?

How long will the dog be left alone daily?
Not at all Less than 2 hours 2 to 4 hours
4 to 6 hours 6 to 8 hours Other


How much time will you spend with the dog in an average day?

Where will the dog stay while alone during the day?

What are your thoughts on dog crates?

Have you ever taken a dog through obedience? Yes No If yes, where:

What type of food will you feed and why?

How else have you tried to obtain a Samoyed?

How did you learn about the Samoyed breed and our rescue?

Check the reasons why you would like to adopt this pet:

Companion Breeding
Gift Watchdog
Hunter Companion for other dog

Do you feel that a pet is supposed to be a lifetime obligation? Yes No

When you go on vacation, where will your dog go and who will care for it?

What reasons do you think justify getting giving up on a dog?

APPLICANT: please give us detailed thoughts on the statements below. Do not simply answer 'YES' and 'NO'. This is a required part of the application process.
What will your first day with your new dog be like?
If your dog has a housebreaking accident when you are not home, how will you deal with it? How about when you are home?
If your dog chews an inappropriate object, what will you do?
What are your feeling on obedience training? If you are not interested, why not?
Our rescue dogs are not all perfect. Are you willing to put extra effort in the dog becoming obedient if necessary?
How do you feel about periodic calls and visits for us to check on the dog to she how s/he is doing?
Why did you choose a rescue group as opposed to a breeder to adopt a dog?
How do you feel about the fact that if you adopt a dog from us you will be signing a contract, and if we find you have breached the contract we legally have the right to remove the dog immediately?
What form of discipline will you use on your dog?
If you have to move, what will you do with your pet?
It may take a while for your new pet to adjust to his/her new home. What concerns do you have about this adjustment period?
Will you call us if you have any concerns or problems?
Yes No
Not sure
Do you have any questions, comments, or concerns?

Will you allow a PLAYING AGAIN SAMS OF WISCONSIN representative to visit your home? Yes No

Veterinarian's name and phone number:

References: Please provide at least 2 references we may contact.

Phone number


Phone number


Phone number

All of the information I have provided on this application is, to the best of my knowledge, true and complete. I understand that falsifying answers on this application, or at any other times during the adoption process, disqualifies me from adopting from Playing Again Sams of Wisconsin.

Signatures: Date: