Date

MM

DD

YYYY

Is this your first husky? *

Yes

No

Applicant Name *

First Name

Last Name

Birthday *

Applicants must be 21. Younger requires board approval.

MM

DD

YYYY

Applicant Phone *

(###)

###

####

Applicant Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you rent or own this address? *

Rent

Own

Co-Applicant Name

First Name

Last Name

Have you owned all pets at least 1 year? *

Yes

No

N/A

Are all pets spayed or neutered? *

Yes

No

N/A

Are all pets on heartworm/flea/tick prevention? *

Yes

No

N/A

Are you willing to adopt an older dog? *

Yes

No

A dog with a physical handicap? *

Yes

No

A dog that requires regular medication or care for a disorder/disease? *

Yes

No

Do you understand that adopting is a life-term commitment? *

Average lifespan of huskies is 10 to 14 years.

Yes

No

Do you have a properly fenced yard? *

No holes or gaps and height varies based upon dog

Yes

No

Do you have any training experience? *

Yes

No

All dogs require supervision with children? *

Yes

No

Would you be willing to take training classes and/or work directly with rescue if necessary? *

Yes

No

Obtain a crate if necessary? *

Yes

No

Aware that huskies are known escape artists, known diggers, love to run, and shed profusely? *

Yes

No

Willing to have a rescue representative meet you at your home at a mutually convenient time? *

Yes

No

Reference 1 *

First Name

Last Name

Phone *

(###)

###

####

Reference 2 *

First Name

Last Name

Phone *

(###)

###

####

Reference 3 *

First Name

Last Name

Phone *

(###)

###

####

Reference 4

First Name

Last Name

Phone

(###)

###

####