<p> Siberian Husky Rescue “Pulling For A Brighter Day”</p><p>P.O. Box 351, Galway, NY 12074</p><p>Email: [email protected] </p><p>Siberian Husky Adoption Waiting List Info</p><p>To better match you with a rescue Siberian Husky, please fill out this questionnaire. We’ll keep it on file. For multiple choice questions, circle appropriate choices. If you fill this form out on your computer, delete the answers that don’t apply.</p><p>Date How did you learn about Tundra Spirits Siberian Husky Rescue?</p><p>Potential Adopter(s) Name(s) Work Phone Employer Position</p><p>Home Phone Email Street Address City/State/Zip Number of Age Adults Range Number of Ages Children Do all members of the home know you’re interested in Yes No adopting a dog? Has any household member been convicted of animal Yes No cruelty or of violating animal control laws?</p><p>About Your Home Type House Townhouse Apartment Duplex Other: Setting City Suburb Small Town Country Ownership Own Rent If renter, landlord name/phone Chemically Treated Lawn Yes No Children Visit Rarely Occasionally Often Other Animals in Your Home Type/Name Age Sex Altere Characteristics d (friendly/dominant/shy, etc.)</p><p>Previous Pets (last 10 years) Type/Name Age Sex Altere Where are they now? (If deceased, d give reason)</p><p>Containing the Dog Fenced Yard? Yes No If Yes, Type/Height Do you have a chain-link dog Yes No kennel? Do you have a trolley, chain Yes No or other device used to tie a dog outdoors? Will you consider crating the Yes No Do you own a Yes No dog? crate? Where will the dog be during the day? At night? Is someone home during the Yes No Hours dog will be day? alone</p><p>Your Interest / Knowledge of Siberian Huskies Have you owned a Siberian Husky Yes No before? Are you familiar with the Yes No characteristics and temperament of Siberian huskies? Why do you want a Siberian husky? Other breeds you might like?</p><p>How will the dog be exercised? Have you ever participated in Yes No obedience training with a dog? Do you plan to do obedience Yes No training? Preferences (if any) l l l</p><p> e e e r r r a a a r r r i i i e e e t t t a a a f f f n n n C C C e e e</p><p> r r r e e e t t t ’ ’ ’ s s s P P P s s s n n n E E E o o o D D D Male Travels well Won't need obedience training Female Will run with Obedience competition jogger potential Purebred Plays fetch Can eventually go off leash Good with High energy Other: children level Good with Low energy dogs level Good with cats Doesn't jump up Friendly Doesn't chew Age Any Young Over 5 Over 8 Range: Size Any Toy Small Medium Large Giant Color / Coat / Other We would consider fostering a dog that Yes No doesn’t match our preferences while waiting to adopt.</p><p>Two References (relative, neighbor, friend) Name Phone Relationship</p><p>Veterinarian Name Phone Address</p><p>Have you Yes No previously used If Yes, please give their staff permission for a rescue volunteer to talk to them about your this vet? pets’ medical history.</p><p>Other Rescues You’ve Applied To Other rescues you’ve applied to:</p><p>Certification All information in this form is correct to the best of my knowledge. I understand that if I’ve misrepresented any facts, Tundra Spirits Siberian Husky Rescue may remove the adopted dog from my home. Signature Date Signature Date If you return this application electronically, your typed name is considered your legal signature. Mail to: Tundra Spirits Siberian Husky Rescue, P.O. Box 351, Galway, NY 12074 or e-mail to: [email protected]</p>