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For now, we are low-tech....that means you must print this application out on your printer, then mail it via snail mail to the address printed at the end of the application.
Thanks in advance for considering a rescue Siberian Husky!
APPLICATION TO ADOPT A SIBERIAN HUSKY FROM NEBRASKASIBERIANS.ORG
Contact Information:
Full Name:
Email (optional):
Street address:
City/state/zip:
Home and/or cell phone:
Occupation:
Work telephone:
Personal References (No more than 1 family member):
Reference 1:
Full Name:
Relationship:
Email (optional):
Street address:
City/state/zip:
Home and/or cell phone:
Reference 2:
Full Name:
Relationship:
Email (optional):
Street address:
City/state/zip:
Home and/or cell phone:
Reference 3:
Full Name:
Relationship:
Email (optional):
Street address:
City/state/zip:
Home and/or cell phone:
Siberian Husky Experience:
Ownership:
Have you ever owned a Siberian Husky or Siberian Husky Mix?
If you have owned a Siberian Husky, please describe:
If you have owned a Siberian Husky Mix, please describe:
Breed Research:
Have you done any research on the breed? If yes, check all that apply:
_____I have owned a Siberian Husky.
_____I have done research on the internet.
_____I have read book(s) about the breed.
_____A family member owns a Siberian Husky.
_____A friend owns a Siberian Husky.
_____I have talked to people who own Siberian Huskies.
_____Other (please describe)
Were you aware of the following Siberian Husky traits (check all those you were/are aware of):
_____Friendly with strangers; not good guard dogs, and not territorial like most dogs.
_____Shed moderately year round, profusely twice a year.
_____Love to dig.
_____Many Siberians are accomplished escape artists.
_____Known to run right through "invisible" fencing when on a mission.
_____Love people and require lots of companionship.
_____Have a high prey drive, will hunt small and large prey (including cats, bunnies, and many farm animals).
_____Very smart, adaptable dogs, but have a mind of their own.
_____Not trustworthy off lead.
Pet Ownership:
Past Feline Ownership:
_____I have never owned cats.
_____I have owned _____(#) cats in the past 10 years.
Briefly describe what happened to the cat(s) you no longer have.
Current Feline Ownership:
____I presently own _____(#) cat(s).
Is your cat(s) declawed?
Is your cat an outdoor or indoor cat?
Has he/she ever interacted with dogs?
Please describe your cat(s) interaction with dogs.
Please add any additional cat comments you wish to make:
Past Canine Ownership:
_____I have never owned dogs.
_____I have owned _____(#) dogs in the past 10 years.
Briefly describe what happened to the dog(s) you no longer have.
Current Canine Ownership:
____I presently own _____(#) dog(s).
Please list for all dogs you presently own:
1. Name
2. Breed
3. Age
4. Sex
5. Spayed or Neutered?
Other Pets you Currently Own:
Veterinarian Reference:
Name
Clinic
Phone
Is this your current veterinarian? If not, please explain.
ADOPTION INFORMATION:
Why have you chosen a Siberian Husky?
List all the plans for this dog (check all that apply):
_____Family Pet
_____Obedience/AKA Canine Good Citizen
_____Daily Walks/Runs/Hiking
_____Therapy Assist Dog
_____Agility
_____Other activities yet to be discovered.
Do you want to adopt a: male female either
(If you have a gender preference, please explain your reasoning.)
Color preference:
Age preference:
(If you have an age preference, please explain your reasoning.)
Are you interested in a particular dog you've seen advertised through rescue?
If so, which one?
PLACE OF RESIDENCE INFORMATION:
Dwelling Information:
Do you own or rent your home?
If renting, do you have the landlord's permission to keep a dog?
Landlord Reference: (If renting, please list the landlord's contact information):
Name:
Organization (if any):
Phone:
Type of dwelling: (Single home, duplex, apartment, farm, etc.)
How long have you lived at this address?
Do you have any future plans of moving?
If you move, what are your plans for this dog if you adopt?
Do you have a fenced in yard?
If yes, check all that apply:
Under 4' 4' 5' 6' or higher
Chain Link Picket Invisible Privacy Other
How large is the fenced in area?
If no fence, how will you handle exercise and toilet duties?
If no fence, do you plan to fence in the yard?
If so, when?
OCCUPANTS AND OWNERSHIP INFORMATION:
How many adults are in your household?
How many children (under 18) are in your household?
Please indicate the ages of all children:
Who will be the primary caregiver for this dog?
Age of primary caregiver (if under 18):
Is everyone in the household aware of and agreeable to your interest in adopting a Siberian Husky?
Have or will children be taught how to appropriately interact with an animal?
Given the Siberian personality for escaping and roaming, will you teach all household members the importance of never taking the dog out without a lead, and the importance of making sure all gates and doors are secure?
Are there regular visitors to your home (human or animal) with which your new dog must get along?
Please describe:
THE NEW DOG
Where will the dog spend the day? (check all that apply):
Loose indoors Crate Basement Garage
Loose Outdoors Tied Up Outside Kennel Run Other
If other, please describe.
Where will the dog spend the night? (check all that apply):
Loose indoors Crate Basement Garage
Loose Outdoors Tied Up Outside Kennel Run Other
If other, please describe.
How many hours on average will the dog spend alone?
Who will care for your dog(s) when you are on vacation or business trips?
If military, are you likely to be transferred to a new location?
How will you handle being transferred to a new area as it concerns your dog?
OTHER INFORMATION
Do you agree to let a representative of NebraskaSiberians.org visit your home from time to time?
Do you agree that, in the event you can no longer care for this dog, you will immediately contact NebraskaSiberians.org and sign the dog back over to rescue at a time and place appropriate for the situation at hand?
By signing this form, you attest that all the information you have provided in this application is true and correct, and you authorize NebraskaSiberians.org to check the references stated within.
Thank you for taking the first step towards giving a second-hand dog first-class love.
By signing this application, I certify that all the above is true and correct to the best of my knowledge:
Primary Applicant Signature_______________________________________________
Printed Full Name ___________________________________
Secondary Applicant Signature_______________________________________________
Printed Full Name ____________________________________ | 
