PERSONAL INFORMATION

NAME:

ADDRESS:

COUNTY: Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia DeSoto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Miami-Dade Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Sumter Seminole St. Lucie Sarasota Suwannee St. Johns Santa Rosa Taylor Union Volusia Wakulla Walton Washington

CITY: STATE: Florida Georgia Alabama Louisiana ZIP:

HOME PHONE: WORK PHONE: CELL PHONE:

E-MAIL:

PLANNING ON MOVING IN THE NEXT... 3 Months 6 Months 1 Year Over 1 Year Not Moving

IF MOVING, DO YOU PLAN ON MOVING OUT OF STATE IN STATE

YOUR AGE RANGE: Under 18 18-20 21-25 26-35 36-45 46-55 56-65 66-75 Over 76

FOR STATISTICAL PURPOSES WHAT ARE THE OCCUPATIONS OF ALL ADULTS IN THE HOUSEHOLD:

ARE YOU OR YOUR SPOUSE WITH THE MILITARY? YES NO

IF YOU ANSWERED YES TO BEING IN THE MILITARY ARE YOU... ACTIVE INACTIVE/RETIRED

IF HAVE YOU APPLIED TO ADOPT FROM OTHER RESCUES PLEASE NAME THEM

VET'S INFORMATION (Most Recent in past 2 years.)

Vet's NAME:

Vet's ADDRESS:

Vet's PHONE NUMBER:

Vet's EMAIL ADDRESS:

IF YOU HAVE USED THIS VET FOR 1 YEAR OR LESS PLEASE PROVIDE PREVIOUS VET INFORMATION:

MAY WE CONTACT YOUR VET? YES NO

IF YOU DO NOT HAVE A VET...HAVE YOU LOOKED INTO VETS IN YOUR AREA FOR THE NEW DOG? YES NO

DO YOU GET ANNUAL SHOTS FOR YOUR PETS? YES NO

DID YOU READ THE HEARTWORM SECTION OF OUR EDUCATION PAGES? YES NO

DO YOU GET AN ANNUAL HEARTWORM TEST ON YOUR PETS? YES NO

DO YOU GET AN ANNUAL PHYSICAL EXAM FOR YOUR PETS? YES NO

DID YOU READ THE FLORIDA'S PARASITES SECTION OF OUR EDUCATION PAGES? YES NO

DESCRIBE YOUR ANNUAL VET VISIT, e.g.for shots, routine physical, etc.

ARE YOUR CURRENT PETS SPAYED/NEUTERED? YES NO

DO YOU USE HEARTWORM PREVENTATIVE? YES NO

IF YES, WHAT BRAND? ..... None Heartgard Interceptor Sentinel Revolution ProHeart 6 (6 month shot) Ivomec

DO YOU USE FLEA/TICK PREVENTATIVE? YES NO

IF YES, WHAT BRAND? ..... None Frontline Advantage Program Revolution K9 Advantix

RESIDENCE INFORMATION

HOME STYLE: ..... Single Family Home Multi Family Home Townhouse Condominium Mobile Home Apartment DESCRIBE YOUR COMMUNITY: ..... Suburban Urban Rural

DO YOU HAVE A FENCED IN YARD? YES NO

IF YES PLEASE DESCRIBE:

HOW MANY PEOPLE LIVE IN YOUR RESIDENCE:

HOW MANY CHILDREN LIVE WITH YOU OR VISIT FREQUENTLY:

DO YOU OWN OR RENT/LEASE? OWN RENT/LEASE

ANY DEED RESTRICTIONS? YES NO

IF YOU RENT OR HAVE DEED RESTRICTIONS PLEASE GIVE THE FOLLOWING:
(*Note: A letter from your landlord or homeowner's association indicating a dog of this size is authorized in your home will be asked for. Your application cannot be processed without this information)

LANDLORD/PROPERTY MANAGER'S NAME:

LANDLORD/PROPERTY MANAGER'S ADDRESS:

LANDLORD/PROPERTY MANAGER'S PHONE NUMBER:
NOTE: We will be contacting your Landlord for a verbal approval also.

ARE YOU ALLOWED PETS OVER 50 LBS? YES NO

CURRENT PET OWNERSHIP INFORMATION

PLEASE LIST ALL PETS OTHER THAN DOGS AND CATS:

HAVE THESE PETS INTERACTED WITH DOGS? YES NO

HOW MANY DOGS DO YOU CURRENTLY OWN?:

PLEASE LIST ALL YOUR DOGS NAMES, AGE AND BREED:

HOW MANY DOGS HAVE YOU OWNED IN LAST 10 YEARS?

BRIEFLY DESCIBE WHAT HAPPENED TO THE DOGS YOU NO LONGER HAVE:

HOW MANY CATS DO YOU CURRENTLY OWN?

ARE THE CATS DECLAWED? YES NO

IS YOUR CAT AN INDOOR OR OUTDOOR CAT? INDOOR OUTDOOR INDOOR AND OUTDOOR

HAS THE CAT(S) INTERACTED WITH DOGS? YES NO

PLEASE DESCIBE YOUR CAT(S) INTERACTIONS WITH DOGS:

HOW DO YOU FEED YOUR PETS:

HOW WILL YOU INTRODUCE THE NEW DOG TO YOUR FAMILY AND CURRENT PETS:

IF YOU HAVE DOGS CURRENTLY HAVE YOU READ THE MULTIPLE DOG SECTION OF OUR EDUCATION PAGES?
YES NO

HAVE YOU EVER OWNED A SIBERIAN HUSKY? YES NO

HAVE YOU DONE ANY RESEARCH ON SIBERIAN HUSKIES? (check all that apply below) YES NO

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 SHRF HUSKY EDUCATION PAGES

A FAMILY MEMBER OWNS A SIBERIAN HUSKY A FRIEND OWNS A SIBERIAN HUSKY

I HAVE TALKED TO PEOPLE WHO OWN HUSKIES

HOW WOULD YOU DEAL WITH A DOG THAT SHEDS A LOT?

HOW MANY HOURS A DAY WILL THE DOG BE ALONE?

WHERE WILL THE DOG BE KEPT WHEN NOBODY IS HOME? INDOORS OUTDOORS CRATE KENNEL RUN BACKYARD BACKYARD W/ ACCESS TO GARAGE OR ROOM FREE ROAM OF THE HOUSE
You can select multiple items by holding the "CTRL" button down

WHERE WILL THE DOG BE KEPT AT NIGHT? INDOORS OUTDOORS CRATED KENNEL RUN FREE ROAM OF HOUSE A DOG BED OUR BED BEDROOM FLOOR WHEREVER IT WANTS
You can select multiple items by holding the "CTRL" button down

ARE YOU WILLING TO CRATE TRAIN YOUR NEW SIBERIAN? YES NO PREFER NOT TO CRATE

ARE YOU WILLING TO TAKE YOUR NEW SIBERIAN TO OBEDIENCE CLASSES OR TO A BEHAVIORIST IF PROBLEMS ARISE? YES NO

WHAT WOULD YOU DO IF YOUR NEW SIBERIAN GOT LOST OR STOLEN?

WHERE IS THE NEAREST ANIMAL SHELTER?

HAVE YOU EVER BEEN CONVICTED OF ANIMAL CRUELTY OR HAD A COURT ORDER AGAINST YOU PREVENTING YOU FROM OWNING OR BEING NEAR ANY ANIMALS, EVEN FOR A SHORT PERIOD OF TIME? YES NO

IF YES PLEASE DESCRIBE THE CIRCUMSTANCES

SIBERIAN PREFERENCES

SEX: MALE FEMALE NO PREFERENCE COAT COLOR: BLACK/WHITE GRAY/WHITE RED/WHITE WHITE AGOUTI SABLE/WHITE NO PREFERENCE

EYE COLOR: BROWN BLUE BI-EYES PARTI-EYES NO PREFERENCE AGE: SENIOR AGES 7 AND UP ADULT AGES 4-6 YEARS YOUNG ADULT AGES 1-3 YEARS PUPPY AGES 6-11 MONTHS

CHARACTERISTICS: HOUSEBROKEN PRESCHOOL CHILDREN SCHOOL AGE CHILDREN TEENAGERS SENIORS GOOD W/SMALL DOGS GOOD W/LARGE DOGS GOOD W/CATS GOOD W/LIVESTOCK
You can select multiple items by holding the "CTRL" button down

DOG(s) YOU ARE INTERESTED IN: NAME(S) DOG (s) ID #(s):

WHY DO YOU WANT A SIBERIAN HUSKY?

HOW MUCH DO YOU THINK IS THE AVERAGE ANNUAL COST TO OWN A DOG?

$100 $250 $500 $800 $1000 OVER $1000

HAVE YOU SEEN THE DISNEY MOVIE 'EIGHT BELOW' YES NO

WHAT ARE YOUR COMMENTS ON THE MOVIE?

REFERENCES (*We need at least 3 references not related to you, i.e. other pet friends, pet sitters, long term friends, co-workers, etc.)

3 references MUST be completed, including phone numbers, or your application will be denied!

NOTE: Family members (living with you or not) are NOT acceptable as references and will cause a significant delay in the processing of your application

REFERENCE #1:

REFERENCE #2:

REFERENCE #3:

By filling out this Adoption Agreement I/we (the undersigned) are aware that this does not guarantee me/us a dog to adopt from Siberian Husky Rescue of Florida, Inc. I/we in turn acknowledge there will be a background check and Home Inspection before I/we are able to adopt a prospective dog. I/We are aware there is a $100.00 - $300.00 adoption donation.* (This includes the $15 fee to transfer the microchip into my/our name if we are approved to adopt.)

SHRF reserves the right to approve or deny any adoption for any reason and to not disclose the reason.

*Suggested Adoption donations may vary based on age, health and veterinary expenses required for an individual Siberian Husky. For Rescue Dogs 1 year of age or less we request a $300.00 adoption donation.