| Applicant |
| First
Name: |
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| Last
Name: |
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| Address: |
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| City: |
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| State: |
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| Zip |
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| Age
of Applicant |
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| Home
Phone: |
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| Work
Phone: |
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| Email: |
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| Employer: |
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| Co-Applicant |
| First
Name: |
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| Last
Name: |
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| Address: |
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| City: |
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| State: |
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| Zip |
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| Age
of Applicant |
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| Home
Phone: |
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| Work
Phone: |
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| Email: |
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| Employer: |
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| Applicant |
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| List
people who live at your current residence: including their
names, relationship to you and ages of children. |
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Residence
Information
|
| Home |
Check
which best describes your residence:
Own single family home
Rent or lease a single family home
Own/Rent a Townhouse-Condo
Other |
| Do
you have a homeowner's association that may have
restrictions on pet ownership? |
| If
you rent, please list the landlord's contact information. |
|
| Yard |
| Is
your yard or a portion of your yard securely fenced?
|
| If
yes, list type, dimensions and height. |
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| Is
the fence solid and secure? |
| What
type of gates? |
| Do
you have plans to modify your fencing before adoption?
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| If
so, describe the changes you plan to make. |
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| Do
you agree to a home check by a rescue representative at an
agreed upon time and day? |
| Note:
all family members and other pets must be present for the
home check. |
|
Pet
Ownership |
| Family
Pets |
| List
all pets currently residing at your residence: including
breed, age & sex. |
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| Are
all of your pets neutered? |
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| If
not, explain your reasons. |
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| Canine
Experience |
| How
many dogs have you owned in the last 10 years. List breeds
and what happened to the dog(s) you no longer have. |
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Veterinary
Information |
| Provide
the name, address and phone number of your veterinarian
who can confirm vaccination records on your current pets.
By so doing, you grant permission for us to contact
him/her for reference. If you no longer have a pet, please
provide the name of the last veterinarian who cared for
your pet(s). |
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| Have
you ever attended basic obedience classes? |
| Why
have you decided to adopt a Siberian husky? |
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| What
research have you done on Siberian huskies? |
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| Have
you read "So...you want a Siberian Husky" by the
Siberian Husky Club of America? |
| Note:
this can be found on our website www.siberiansneedingowners.org
under breed information. |
| Who
will have primary responsibility for the care of your new
dog? |
|
Where
will your Siberian stay when you are not home?
Loose indoors
Crate
Loose outdoors in fenced yard
Kennel or Run
Garage
Other |
| If
other, please describe. |
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| Where
will your Siberian sleep at night? |
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| Are
there any frequent visitors to your home, either human or
animal with which your dog must get along? |
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| Please
describe any other information that you wish us to
consider when reviewing this application. |
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| Which
available SNO dog are you interested in adopting? |
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