1.    Which dog are you interested in?

2.    Are you looking to adopt now or in the future?

2a.   Have you applied for adoption with any other rescues or shelters 

       at this time?  Choose One Yes No  With what group(s)?

3.    How did you hear about our rescue group?

4.    Name:    E-Mail:
       Address:    City/State/Zip:
       Day Phone:    Evening Phone:
       Best Time to Call:

5.    Please provide the contact information of a veterinarian you have used before.  Veterinarian references are checked.
       If you plan to use a new veterinarian please list as well.
       Veterinarian Name:    Veterinarian Phone:
       Veterinarian records are under the name of:
       New Veterinarian Name:    New Veterinarian Phone:

6.    Please provide the names and phone numbers of two personal references we may call.
       Reference Name:    Phone:
       Reference Name:    Phone:

7.    Please list place of employment for yourself and your spouse.  We do NOT call employers, this is simply for our records.
       Employer Name:    Employer Address:    Employer Phone:
       Spouse Employer Name:    Spouse Employer Address:
       Spouse Employer Phone:

8.    What kind of residence do you live in (choose one):
       Rent Apartment    Rent Home    Own Home    Own Condo    Other

9.    How long have you lived here?

10.  What floor do you live on?

11.  Do you have a terrace?

12.  Are you moving in the near future? Choose One Yes No    If yes, please explain:
      

13.  If you rent or own a condo, please provide your landlord's contact information so we may verify that you are allowed a pet(s).
       Landlord Name:    Landlord Phone:

14.  Is everyone in the household aware of and agreeable to your interest in adopting?

15.  Does anyone in your household have asthma or any known allergies to dogs or cats?

16.  Please list below all people who currently live at this residence (including yourself):
       Name:    Age:    Relation:
       Name:    Age:    Relation:
       Name:    Age:    Relation:
       Name:    Age:    Relation:
       Name:    Age:    Relation:

17.  Please list below all current pets:

    Name:    Age:    Type: Choose One Dog Cat Fish Reptile Other    Breed: Sex: Choose One Male Female 
    Where Obtained:     How Long Owned:    Kept Where:
    Cats Declawed: Choose One Yes No n/a

    Name:    Age:    Type: Choose One Dog Cat Fish Reptile Other    Breed:    Sex: Choose One Male Female
    Where Obtained:     How Long Owned:    Kept Where:
    Cats Declawed: Choose One Yes No n/a

    Name:    Age:    Type: Choose One Dog Cat Fish Reptile Other    Breed:    Sex: Choose One Male Female
    Where Obtained:     How Long Owned:    Kept Where:
    Cats Declawed: Choose One Yes No n/a

    Name:    Age:    Type: Choose One Dog Cat Fish Reptile Other    Breed:    Sex: Choose One Male Female
    Where Obtained:     How Long Owned:    Kept Where:
    Cats Declawed: Choose One Yes No n/a

18.  Please complete this regarding any other pet you have owned in the past.
      
    Name:    Type: Choose One Dog Cat Fish Reptile Other    Breed:    Age:
    Where Obtained:    How Long Owned:    What Happened:

    Name:    Type: Choose One Dog Cat Fish Reptile Other    Breed:    Age:
    Where Obtained:    How Long Owned:    What Happened:

    Name:    Type: Choose One Dog Cat Fish Reptile Other    Breed:    Age:
    Where Obtained:    How Long Owned:    What Happened:

    Name:    Type: Choose One Dog Cat Fish Reptile Other    Breed:    Age:
    Where Obtained:    How Long Owned:    What Happened:

19.  Have you ever taken on of your pets to a shelter or given an animal away? Choose One Yes No
       If so, Please describe circumstances:
      

20.  Have you previously owned and/or lived with a Siberian Husky?

21.  Are you aware of the following traits of the Siberian husky breed?
       **they are escape artists (thru open doors, over & under fences, thru windows)
       **they should never be allowed to run loose in unfenced areas because they are
       EXTREMELY UNRELIABLE OFF LEASH.
       ** the overwhelming majority of Siberians coming into shelters and rescue groups are strays
       ** blow/shed their coats heavily twice a year
       ** have a very high energy level and need a lot of exercise
       ** are very intelligent, can be stubborn and are not terribly obedient
       ** can have a high prey drive with small animals (e.g. cats, birds, squirrels, hamsters, etc)

22.  Given the Siberian personality for escaping and roaming, will you teach all household members the:
       ** making sure the dog is ALWAYS wearing identification tags on his/her collar?
       ** never taking the dog out without a lead/leash?
       ** making sure all gates and doors are securely closed?

23.  Do you have a completely fenced in area on your property? Choose One Yes No
       If yes, please continue the following questions:
       Height and type of fencing?
       Can strangers gain access to your yard?
       What type of lock do you have on your gate?
       Do you have a pool? Choose One Yes No    Type: Choose One In Ground Above Ground n/a    If yes to all, Is it fenced in? Choose One n/a Yes No

24.  If you have no fence, how do you plan to have your new dog relieve and exercise itself?
      

25.  What out door activities would include your dog?
      

26.  Who will be responsible for the care of this dog?

27.  Do all adults work full time?

28.  How many hours each day will your new dog be alone?

29.  How many hours each day will you spend time with your dog?

30.  Where will your new dog be kept when it is alone?

31.  Where will you new dog be kept during the day?

32.  Where will your new dog sleep at night?

33.  Will you be crating the dog? Choose One Yes No    If yes, When and for how many hours?
      

34.  Will the dog be allowed on the furniture? Choose One Yes No
       If No, how do you plan to get the dog off the furniture if she/he does jump up there?
      

35.  Do you plan to rough-house (play rough) with this dog?

36.  Are you familiar with positive methods (no hitting) of dog training?

37.  We may require certain dogs to attend training classes, is this acceptable?

38.  Would you like a trainer recommendation?

39.  Are there regular visitors to your home (human/animal) with which your new dog must get along with? Choose One Yes No
       If yes, Whom:
      

40.  What kind of food do you plan to feed your new dog? (check all that apply)
       Dry        Brand:    Times/Day:
       Wet   

41.  Do you plan to give your pet heartworm preventative? Choose One Yes No
       If yes, what brand?

42.  Where do you purchase your pet's heartworm preventative?

43.  Do you plan to use flea/tick preventative? Choose One Yes No
       If yes, what brand?

44.  Where do you purchase your pet's flea/tick preventative?

45.  Who will care for you pet(s) when you are on vacation?

46.  What is the name of your local animal shelter(s)?
      
      

ADOPTION DONATION

This donation is $275-400. We will no longer accept personal checks.  All adoption fees must be in cash or certified check.  We do not make money on our rescue dogs. This donation helps to offset our expenses. All of our rescues are spayed/neutered, vaccinated, heartworm  tested, microchipped, wormed, have a new leash and collar and are groomed.  Senior dogs have a blood panel done.  We also pay for the following expenses: Shelter fee to have the dog released into our rescue group; Kennel fees to board the dog till he/she finds their own home unless a foster home is available. This donation enables us to continue our rescue efforts. This donation is non-refundable. Is this acceptable? Choose One Yes No

The adoption procedure includes filling out this application, a phone interview, meet the dogs/in- person interview, contract signing (which stipulates the animal MUST be returned to us if you can no longer keep it), home visit prior to adopting and one or more follow up visits and also delivery of the dog to your home. This is all to ensure the safety of the dog since we don’t know you.

Please realize that dogs need vet care throughout their lives, including yearly checkups, boosters or vaccination titer tests, heartworm and flea/tick preventative meds, etc. If you cannot afford a donation, can you afford the appropriate vet care? Choose One Yes No    Adopting companion animal is a long term commitment of at least 12-15 years (pending on age of animal), please consider this before adopting.  Is this acceptable? Choose One Yes No    If no, why?


**PLEASE REMEMBER THIS DOG HAS ALREADY BEEN ABANDONED ONCE BEFORE**

Are these terms acceptable to you? If so, please sign: