* 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

A VOLUNTEER WILL BE CONTACTING YOU,

WHAT IS THE BEST PHONE NUMBER TO USE?:

WHAT IS THE BEST TIME OF DAY TO CONTACT YOU?:

DO YOU PLAN ON MOVING IN THE NEXT... 3 Months 6 Months 1 Year Over 1 Year Not Moving

IF YOU ARE MOVING, DO YOU PLAN ON MOVING Out of state? In state?

WHAT IS YOUR AGE RANGE? Under 18 18-20 21-25 26-35 36-45 46-55 56-65 66-75 76 or over

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

ARE YOU OR YOUR SPOUSE IN THE MILITARY? Yes No

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

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

HOW DID YOU HEAR ABOUT SIBERIAN HUSKY RESCUE OF FLORIDA?

VETERINARIAN INFORMATION: (Most recent in past 2 years.)

Vet's Name:

Vet's Address:

Vet's phone number:

Vet's email address:

IF YOU 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 USE HEARTWORM PREVENTATIVE? YES NO

IF YES WHAT BRAND? None Heartgard Interceptor Sentinel Revolution ProHeart 6 (6 mth shot) Other

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

DO YOU USE FLEA/TICK PREVENTATIVE? YES NO

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

DESCRIBE YOUR ANNUAL VET VISIT, I.E. For shots, routine physical, etc.

ARE YOUR CURRENT PETS SPAYED/NEUTERED? YES NO

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?

HOW MANY CHILDREN VISIT FREQUENTLY?

PLEASE LIST ALL THE CHILDREN'S AGES:

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

DOES YOUR HOME HAVE ANY DEED RESTRICTIONS? YES NO

LANDLORD/PROPERTY MANAGER'S NAME:

LANDLORD/PROPERTY MANAGER'S ADDRESS:

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

ARE YOU ALLOWED PETS OVER 50 LBS? YES NO

PET OWNERSHIP INFORMATION:

PLEASE LIST ALL PETS OTHER THAN DOGS AND CATS IN YOUR HOME:

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 Both indoor and outdoor

HAVE YOUR CAT(S) INTERACTED WITH DOGS? YES NO

IF YES, PLEASE DESCIBE YOUR CAT(S) INTERACTIONS WITH DOGS:

HOW OFTEN DAILY DO YOU FEED YOUR PETS:

WHAT TYPE OF DOG FOOD DO YOU USE? (check all that apply below)

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

:

IF YOU CURRENTLY HAVE DOGS, 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 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

IN FLORIDA, SIBERIAN HUSKIES SHED LARGE VOLUMES OF HAIR. ARE YOU PREPARED TO DEAL WITH EXCESS SHEDDING? YES NO

HOW MANY HOURS A DAY WILL THE DOG BE ALONE?

WHERE WILL THE DOG BE KEPT WHEN NOBODY IS HOME?

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 SIBERIAN GOT LOST OR STOLEN?

WHERE IS THE NEAREST EMERGENCY ANIMAL HOSPITAL?

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

WHAT IS THE APPROXIMATE DATE WHEN YOU WOULD LIKE TO TAKE POSSESSION OF THE DOG?

WHAT SEX DO YOU PREFER?

Senior - Age 7 years and up Adult - Ages 4-6 Years Young Adult - Ages 1-3 Years Puppy - Ages 6-11 Months No preference
You can select multiple items by holding the "CTRL" button down

IF YOU HAVE A PARTICULAR SHRF DOG(s) IN WHICH YOU ARE INTERESTED ENTER THE NAME(s) HERE.
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

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 $125.00 - $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.

* SIGNATURE OF APPLICANT:

DATE:

SIGNATURE OF CO-APPLICANT:

DATE:

NOTE: Items indicated by * MUST be completed to submit this form. To submit this application please click the submit button below. If the application has been accepted you will be taken to a confirmation screen and you will receive an email with a copy of your submission, otherwise you will see a screen indicating errors in the required data field(s) and you will have to correct them and resubmit the application. If you do not receive a reply from us within 48 hours please call 727-391-8934.