Mapaw - Online Application

Our adoption process requires our volunteers to perform home visits and for that reason, our adoption area is limited to a 100-mile radius of Philadelphia, PA. If you are outside of this area, please go to siberianrescue.com or petfinder.com to locate rescues in your area. And don't forget to check with your local shelters - many Siberians find their way there!

If you have a problem submitting this form please send an e-mail to stacie@sibes.com.

The information you provide in this application helps us to determine which Siberian personality will best match your home. Please fill out this form to the best of your knowledge.

Please indicate whether you are interested in adopting or becoming a foster home:

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

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

Date: Month: Day: Year:

Contact information:

First name:		Last Name:
Occupation:
Street Address:		City:
State:		Zip:
Work Phone:		Best time to call:
Home Phone:		Best time to call:
E-mail:

Personal References: (Please list no more than 1 family member)

Reference 1:

First Name:		Last Name:
Relationship:		Phone:
Street Address:		City:
State:		Zip:

Reference 2:

First Name:		Last Name:
Relationship:		Phone:
Street Address:		City:
State:		Zip:

Reference 3:

First Name:		Last Name:
Relationship:		Phone:
Street Address:		City:
State:		Zip:

Have you ever owned a Siberian Husky? Yes No

If yes, then please describe:

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

Please describe (include if you no longer have the pet(s), please detail what happened to each):

Why have you chosen a Siberian Husky?

List all the plans for this dog: Pet Obedience Exercise Outdoor activities (hiking, mushing) Other

If other, then please describe:

Do you want to adopt a male or female?

Age preference (Select any of the following that apply):

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

Do you own or rent your home?

If renting, do you have the landlords permission to keep a dog?

If renting, please list the landlords contact information:

First Name: Last Name:

Organization: Phone:

Please specify the type of dwelling:

If other, then please describe:

How long have you lived at this address:

Do you have a fenced in yard?

If yes, then please specify (Select all of the following that apply):

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

If other, then please describe:

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

How many adults are in your household?

How many children are in your household? Ages:

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:

Do you own cats? How many? Declawed?

Do you currently own any dog(s)? How many?

Please indicate for each dog: Age, Sex, & Breed:

Do you own any other animals?

If yes, please list:

Do you have a regular veterinarian?

First Name:		Last Name:
Organization:		Phone:

Note: You must contact your vet and give him approval to release information to MaPaw.

Where will the dog spend the day? (Select all of the following that apply):

Loose indoors Crate Basement Garage Loose outdoors Tied up outside Kennel run Other

If other, then please describe:

How many hours on average will the dog spend alone?

Where will the dog spend the night? (Select all of the following that apply):

Loose indoors Crate Basement Garage Loose outdoors Tied up outside Kennel run In bed with owner Other

If other, then please describe:

Do you agree to let a representative of MaPaw visit your home by appointment?

If No, why not?

Comments:

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

Adoption fees are $250.00 unless otherwise stated. This includes spay/neutering, current shots, heartworm testing and preventative and parasite control. Cancelled or invalid adoptions and/or home checks may be subject to processing fees based upon costs incurred by MaPaw Siberian Husky Rescue and Referral Service, Inc.

If you have any problems submitting this form please send an e-mail to: stacie@sibes.com and make sure you describe what happened.

Thank you.

MaPaw Siberian Husky Rescue and Referal Service
Revised: February 10, 2008 .

MaPaw Siberian Husky Rescue and Referal Service Revised: February 10, 2008 .

MaPaw Siberian Husky Rescue and Referal Service
Revised: February 10, 2008 .