Name: 
  Address: 
  City:     State:  ILINIAMIWI
  Postal Code: 
  Country: 
  Daytime Phone:   
  Evening Phone:   
  Cell Phone   :   
  Email:           

  Best time to reach you  MorningAfternoonEvening

  Description of current residence:  ApartmentCondominiumTownhomeTrailerSingle Family Residence
  How long have you lived at your present address?  years.
  Select one?  Own  or Rent 
  
  If renting, please provide landlord's contact information.
  Landlord Name:    
  Landlord Address: 
  Landlord City:     Landlord State:  ALAKAZARCACOCTDEDCFLGAIDILINIAKSKYLAMEMDMAMIMNMOMSMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
  Landlord Postal Code: 
  Landlord Daytime Phone:   
  Landlord Evening Phone:   
  Landlord Email:            
  Occupation of household members:    
  Employer(s):  
  Please list names and ages of all people who will be 
  living with the dog:
  
        

  How did you hear about FSSR?
  Why would you like a Siberian Husky?
  
  Will this be your first Siberian Husky?Yes  No

  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 owned other dogs before?  Yes  No
  If yes, list breed(s): 
  Please List Breeds Here 
            

  List other pets you currently own:
  (Please indicate breed, age, temperment, sex and whether they are 
   spayed/neutered.)
  
            

  Have your current dogs been tested for heartworm?
  Yes  No 

  Are your current dogs on a heartworm preventative?
  Yes  No

  Please list any characteristics your current pets have that
  FSSR should be aware of:
  Please list characteristics of your current pets.
            

  Current Vet:
  Name:    
  Address: 
  City:     State:  ALAKAZARCACOCTDEDCFLIDILINIAKSKYLAMEMDMAMIMNMOMSMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
  Postal Code: 
  Phone:   
            

  Is someone home during the day?
  Yes  No

  Work hours?  
            

  Where will the dog be kept during the day?
  
  Where will the dog be kept during the night?
  
            

  Who will be the primary caretaker of this dog?
  
            

  Do you have a fenced in yard? Yes  No
  Type of Fence: 
  Height of Fence: 
            

  Please describe your exercise plan for your Siberian Husky:
  
            

  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

  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?  
            

  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:
  
            

  What would you do if your dog bit someone?
  
  
  Have you ever had to put an animal to sleep?
    Yes No

  If yes, why did you have to?
  
  
  For what reasons would you give up an animal to a shelter or rescue?
  
  
  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
            

  Husky preference (rescue Siberians typically range in age from 
  1 year to 8 years old):
  Color:    Sex:  ChooseNo preferenceMaleFemale  Age:  
            

  Would you consider a Husky mix?  Yes  No  

    References:

  Please provide the names, addresses, and phone numbers for two
  people who are not relatives and do not reside in your household.

  PLEASE NOTIFY YOUR REFERENCES AFTER SUBMITTING THIS FORM
  THAT WE WILL BE CONTACTING THEM

  Reference #1:
            

  Reference #2:
            

  Please check to make sure you have completed all of the above
  sections, and feel free to use the comments box below to provide
  any further information you feel will help us in evaluating 
  your application.

  Comments:
  
            

We reserve the right to refuse or deny any application.