Adoption Application

ADOPTION APPLICATION

The information you provide in this application helps us to determine which Siberian personality will best match your home. Please fill out this entire application to the best of your knowledge. This application MUST be completed and submitted by an ADULT member of the household.

Once you have submitted your application, one of our volunteers will start the review process. If you have any problems, concerns, or questions regarding this process, please email us.

You will receive an email from our application coordinator within 2-3 days of receipt of your application at the email address provided.

Time Frame:

Indicate the time frame you had in mind for adopting a Siberian Husky:

Why you have selected this time frame?

Contact Information:

Primary Applicant:

(Primary applicant must be over 18 yrs old and will be financially responsible for the adopted dog)

First name:

Last Name:

Occupation:

Age (if under 18):

Street Address:

City:

State:

Zip:

Work Phone:

Best time to call:

Home Phone:

Best time to call:

Cell Phone:

Best time to call:

Our volunteers use their personal phones when calling you and your references. Please help us keep their costs down by providing this information.

Cell Service Provider:

Skype Account If applicable:

Email:

Co-Applicant:

First name:

Last Name:

Occupation:

Age (if under 18):

Email:

Personal References:

No more than 1 family member - THREE REFERENCES ARE REQUIRED!

Reference 1:

First name:

Last Name:

Relationship

Phone:

Best time to call:

Street Address:

City:

State:

Zip:

Email Address:

Reference 2:

First name:

Last Name:

Relationship

Phone:

Best time to call:

Street Address:

City:

State:

Zip:

Email Address:

Reference 3:

First name:

Last Name:

Relationship

Phone:

Best time to call:

Street Address:

City:

State:

Zip:

Email Address:

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: (check all that apply)

Have you done any research on the breed?

Yes

I have owned a Siberian Husky

I have read Book(s) about the breed

I have done research on the internet

I have read the TOTTSHR description

A family member owns a Siberian Husky

A friend owns a Siberian Husky

I have talked to people who own Huskies

Other

If you have indicated that you have done other research, please describe:

Pet Ownership:

Past Feline Ownership:

(if you have never owned cats, please click here to proceed to the next portion of the application)

How many cats have you owned in the past 10 years?

Briefly describe what happened to the cat(s) you no longer have:

Current Feline Ownership:

(if you do not currently own any cats, please click here to proceed to the next portion of the application)

How many cats do you currently own?

Are 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 enter any additional comments regarding yours cat(s) here:

Past Canine Ownership:

(if you have never owned dogs, please click here to proceed to the next portion of the application)

How many dogs have you owned in the past 10 years?

Briefly describe what happened to the dog(s) you no longer have:

Current Canine Ownership:

(if you do not currently own any dogs, please click here to proceed to the next portion of the application)

How many dogs do you currently own?

If you currently have dog(s) please indicate the sex, age, and breed for each dog:
Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

If you currently own more than 6 dogs, please enter the Name, Sex, Age, and Breed for the additional dogs here:

Other Pet Ownership:

(if you do not currently own pets other than dogs and cats, please click here to proceed to the next portion of the application)

Do you currently own any other animals?

If yes, please list:

Veterinarian Information:

Do you have a regular veterinarian?

Vet Reference:

First name:

Last Name:

Organization:

Phone:

Is this the vet you currently use?

If this is not your current vet please explain:

Adoption Information:

Why have you chosen a Siberian Husky?

Energy level preference: (check all that apply)

High Energy
Outdoorsy
Lap dog
Athletic (hiking, mushing)
Quiet
Very Affectionate
Couch Potato
Spunky
Adventurous
Sled Dog
Other

If other, please describe:

Why do you want a dog? (check all that apply)

Companion
Watch dog
Gift
To Breed
Playmate for current dog
For kids
Sled dog
Replace previous dog
Other

If other, please describe:

Do you want to adopt a male or female?

If you have a preference in the sex of the dog you wish to adopt, please explain you reasoning:

Age preference: (check all that apply)

Under 1 2-3 4-5 6-7 8-9 10 and older

Please explain the reasoning for your age preference:

Personality & Behavior preferences: Please check the level of importance to you for each category listed below. All dogs are kept in foster care and we do our best to assess each dog in many categories and this information will help us to make the right match with you and your home.

	Not Necessary	Willing To Work With	Preferred	Absolute Must
Housebroken Dog
Crate-trained
Trustworthy in the house alone
Gets along with other dogs
Gets along with small dogs
Gets along with cats
Walks nicely on leash
Trustworthy off leash
Good with young children
Good with infants
Dog will NOT dig
Good in a dog park
Has no aggression issues with people
Has no aggression issues with other dogs
Has no aggression issues with small animals
Has NO known medical issues

If you are interested in a specific Siberian Husky displayed on the web site, please indicate which one(s):

If you have listed specific dog(s) you are interested in, please tell us one thing about each dog that sparks your interest:

Please indicate your breed preference:

Please tell us what specific personality traits you are looking for in your new dog:

Are you looking at other breeds of dogs? If so please indicate which breeds and what draws you to those breeds:

Place of Residence Information:

Dwelling Information:

Do you own or rent your home?

Do you live in a Condo/Townhome or any other type of Community Association?

If you live in a Community Association or Rent, is there breed or weight limit restrictions?

If you live in a Community Association or Rent and there are breed or weight limit restrictions, please describe:

If renting, do you have the landlord's permission to keep a dog?

Landlord Reference: (If renting, please list the landlord's contact information)

First name:

Last Name:

Organization:

Phone:

Please specify the type of dwelling:

If other, please describe:

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?

Fence Information:

Do you have a fenced in yard?

If yes, please specify (check that apply):

Under 4 ft. 4 foot 5 foot 6 foot or higher Chain link Picket Invisible Privacy Other

If other, please describe:

If no fence, how will you handle exercise and toilet duties:

If no fence, do you plan to fence in the yard?

If planning to fence in the yard, when do you plan to do so?

If planning on installing a fence, please specify (check that apply):

Under 4 ft. 4 foot 5 foot 6 foot or higher Chain link Picket Invisible Privacy Other
If you plan to use an invisible fence, please read this article.

If other, please describe:

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(s)?

Age of primary caregiver (if under 18):

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

Have your children been 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 In bed with owner 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?

Other Information:

Have you applied to any other rescue groups?

If yes, please list other groups you have applied with:

Please indicate how you heard about about our organization:

If other, please specify:

Please let us know any other information you wish us to consider in placing a dog with you.

(Here is your chance to personalize this application.)

Home Visit and Agreement:

Do you agree to let a representative of TOTTSHR, Inc. visit your home by appointment?

If No, why not?

Which days of the week are best for a home visit?

I/We understand that EVERYONE IN THE FAMILY, INCLUDING OTHER PETS, MUST BE PRESENT AT HOMECHECKS AND THE POTENTIAL ADOPTION APPOINTMENT, NO EXCEPTIONS.

I/We hereby authorize through submission of this form, any veterinarian named above to release any information and records concerning my past or present care of animals to Tails of the Tundra Siberian Husky Rescue, Inc. and I do hereby agree to hold harmless and indemnify said veterinarian for providing such information.

I/We understand that shall the adoption not work out, for any reason, the dog will not be given away, sold or put in a shelter but will be returned to Tails of the Tundra Siberian Husky Rescue.

I/We further understand that completing this application does not guarantee that a dog will be placed with me.

I/We certify by submission of this form that I have never been convicted of any violation of any ordinance or statute enacted pursuant to cruelty, neglect or abandonment of an animal.

I/We will be asked to sign an adoption contract if a dog is placed with my family.

I/We understand that owning a dog is a commitment for the dog's lifetime and if I adopt a dog from Tails of the Tundra Siberian Husky Rescue,Inc, I am willing to make that commitment.

I Agree
I Disagree

Names of applicant(s):

Date:

By pressing the SUBMIT button, you attest that all of the information you have provided in this application is true and correct.

Please do not hit the SUBMIT button more than once. You will receive a confirmation page when your application has been processed.

If you have any problems submitting this form please email us and make sure you describe what happened. You can also print out your application and mail it to: TOTTSHR, PO Box 612, Colmar PA 18915.

Thank you for taking the first step towards giving a second-hand dog first-class love.