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

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: Immediately 1 to 2 weeks 2 to 3 weeks 3 to 4 weeks 6 months 1 year

Date:        Month:   1 2 3 4 5 6 7 8 9 10 11 12   Day:  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    Year:  2008 2009

Contact information:

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

   Reference 1:

  Reference 2:

  Reference 3:

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?    1 2 3 4 5 6 or more 0   

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?    Male 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?    Own Rent

If renting, do you have the landlords permission to keep a dog?    Yes No Does not apply

If renting, please list the landlords contact information:

   First Name:        Last Name:   

   Organization:       Phone:   

Please specify the type of dwelling:    Single home Duplex Twin Townhouse Condo Other

If other, then please describe:   

How long have you lived at this address:    1 2 3 4 5 6 or more    

Do you have a fenced in yard?    Yes No

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?    1 2 3 4 5 6 or more

How many children are in your household?    1 2 3 4 5 6 or more 0     Ages:   

Have your children been taught how to appropriately interact with an animal?    Yes No

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?    Yes No

Are there regular visitors to your home (human or animal), with which your new dog must get along?    Yes No

Please describe:   

Do you own cats?    Yes No     How many?    1 2 3 4 5 6 or more 0     Declawed?    Yes No

Do you currently own any dog(s)?    Yes No     How many?    1 2 3 4 5 6 or more 0

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

Do you own any other animals?    Yes No

If yes, please list:

Do you have a regular veterinarian?    Yes No

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?    1 2 3 4 5 6 7 8 or more 0   

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?    Yes No

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: webmaster, and make sure you describe what happened. 

Thank you.