Application for Adoption for Siberian Husky

We appreciate you filling out this form to the best of your ability as this will speed up the process in approving your application.

Please ensure you have read the Adoption Process which includes important details.

Please note: Upon receipt of your adoption application, we will review your application and will contact you upon verification of your application to set up a time for you to see the dog(s) you are interested in. Free Spirit Siberian Rescue is strictly a volunteer run organization. We appreciate your patience while we review your application. Please do not resubmit your application or send additional emails, as this may further delay the application process. Thank you for choosing to adopt a Rescue Animal.

Please remember, we can only adopt with-in 4 hours of Harvard, Illinois.

About you
First Name		Last Name
Address
City	State IL IN IA MI WI Postal Code
Employer		Occupation
Date of Birth
Phone and Email Information
Day		Evening
Mobile
Email Address
Best time to reach you? Morning Afternoon Evening
Description about your current residence
I currently Own Rent   a   Apartment Condominium Townhome Trailer Single Family Residence   and lived here for   < 1 1 2 3 4 5 6 + year(s).
Do you have a fenced in yard (not required)?		Yes No
What kind of fence is it?		Invisible Wood - with openings Wood - without openings Chain Link Plastic Electric Other
Height of the fence?		< 4 4 6 8 10 12 - feet
Landlord Contact Information
Name
Address
City	State AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MO MS MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Postal Code
Daytime		Evening
Email
Past and Current Pets
Have you owned a dog before?		Yes No
	If Yes, what breed(s) Please List Breeds Here
Will this be your first Siberian Husky?		Yes No
	Why would you like a Siberian Husky?
Are there any pets in your house?		Yes No
	List pets you own:
	Please indicate breed, age, temperament, sex and whether they are spayed/neutered.
	List pets that others (roommates, parents, etc.) may own:
	Please indicate breed, age, temperament, sex and whether they are spayed/neutered.
Have your current animals been tested for heartworm?		Yes No
Are your current animals on a heartworm preventative?		Yes No
Please list any characteristics about the current pets in the household that FSSR should be aware of:
Have you ever had to put an animal to sleep?		Yes No
	If Yes, Why?
Current Vet Information
Name
Address
City	State AL AK AZ AR CA CO CT DE DC FL ID IL IN IA KS KY LA ME MD MA MI MN MO MS MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Postal Code
Phone
About the Rescue Animal
Please indicate Name/Ages of who will be living with this Rescue Animal
Is someone home during the day?		Yes No
For how long normally would he/she be alone for?		1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 hours
Where will he/she be kept during the day?
Where will he/she be kept during the night?
Who will be the primary caretaker?
Please describe plans for care of your dog while away (i.e. vacation):
Are you willing to obtain a crate and crate-train your dog, if necessary?		Yes No
	If No, Why?
What would you do if your Rescue Animal bite someone?
For what reasons would you give up an animal to a Shelter or Rescue?
Would you consider a Husky mix?		Yes No
Your Husky/Mixed Husky preference:
Color: Sex: No preference Male Female Age: No preference < 1 1 2 3 4 5 6 7 8 9 10 + years old
Exercise and Training
Describe your exercise plan for your Rescue Animal
Are you aware that Siberian Huskies shed, are known diggers and escape artists, and love to run?		Yes No
Are you aware the yearly maintenance of a dog is approximately $200 (not including food or grooming)		Yes No
Are you willing to take your dog to a basic obedience course, if necessary?		Yes No
	If no, why?
Do you have the time to house train a dog, if necessary?		Yes No
Describe your house-training method:
References
Please provide the names, addresses, and phone numbers for two people who are not relatives and do not reside in your household. Please also notify the references mentioned below that we will be contact them.
Reference #1	Name/Reference/Number
Reference #2	Name/Reference/Number
Acceptance of Terms
How did you hear about FSSR?
Do you fully understand and accept the fact that a Siberian must never be allowed off leash unless within a fully fenced, secure area, and then never left unattended?			Yes No
Do you also understand that no amount training can ever ensure that a Siberian can safely be off leash or or unconfined, and that not strictly adhering to this restriction will place you Siberian at risk of serious at risk of serious injury or even death?			Yes No
Have you or any household member ever been arrested or convicted of animal abuse or neglect?			Yes No
Are you willing to have a FSSR representative visit your home by appointment?			Yes No
Comments:
We reserve the right to refuse or deny any application.

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