LUNA SIBERIAN HUSKY RESCUE ADOPTION APPLICATION

Luna Siberian Rescue is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals in the southern California shelter system. Luna Siberian Rescue is completely funded through fundraising efforts and public donations. All of our pets receive complete medical care, which includes, vaccinations, spaying/neutering and microchipping prior to their adoption.

This questionnaire is designed to help Luna Siberian Rescue and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Luna Siberian Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!

Name of the dog you are interested in: *

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

What made you decide to adopt a husky ? *

Your full name: *

Your age: *

Street Address: *

City, State, Zip *

Home Phone: *

Area Code Phone Number

Cell Phone: *

Area Code Phone Number

E-mail: *

Employer: *

Work Phone: *

Area Code Phone Number

Job Title

Personal reference (non-family) *

Reference Phone Number *

How many adults reside in the household? *

Please list their names and ages *

Are there any children under age 18 in the home ? *

Yes No

If so, please list their names and ages

Are all members of your household in agreement with this adoption? *

Yes No Don't Know

Who will be the pet's primary caregiver? *

Do you live in a *

House Apartment Condo Mobile Home

Do you own or rent? *

Own Rent

If you rent,please provide name and phone number of your landlord,and answer the following 2 questions below

(please give complete information)

Does your landlord allow dogs?

Yes No

Are there any restrictions from your landlord or subdivision?

Number of pets Size or weight restrictions Breed restrictions None

If there are restrictions, please describe them.

Do you have a fully fenced yard? *

Height and type of fence *

Are there any holes or gaps ? *

Do you have any of the following *

Swimming Pool Cats Small animals - rabbits etc Birds/ chickens None

If you have children, have they been around animals before? *

Yes No Not applicable

Please list the names and ages of any children in the home. If "none" , put N/A *

Does anyone in your home have allergies to dogs or have asthma? *

Yes No

What is your current activity level and how do you plan to make sure your new pet gets exercise? *

List the name,age and type of the pets you currently own *

How many of these pets are spayed/neutered? *

Where are these animals now? *

Have you adopted from an animal welfare group before? *

Yes No

If yes, what group?

Have you ever given up a pet? *

Yes No

If yes, what were the circumstances?

Please provide the name and phone number of your current and/or previous veterinarian or clinic: *

If you do not have a vet reference, please give the name and number of one ADDITIONAL personal reference

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato) *

Have you ever house-broken a dog or puppy before? *

Yes No

If the dog has an "accident" in your home, what type of correction do you plan to use? *

How many hours each day will your new pet be home alone? *

Where will you new dog be allowed during the day when you are home? *

Where will the dog be allowed during the day when you are NOT home?

Where will the dog sleep at night ? *

Are you willing to work through your new pet's issues, if any? *

Yes No

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *

Yes No

Do you plan to take an obedience class with your dog? *

Yes No Not sure

If yes, where?

Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for? *

Yes No

What type of dog food do you use? If you do not have a pet, we can suggest quality foods .

Do you agree to let Luna Siberian Rescue and it's associates to contact your vet and references? *

I agree the fee associated with adopting a dog from the rescue is considered a tax deductible donation to the rescue to support ongoing care for huskies in need. The donation amount is 400.00 for adult dogs. Puppies range from 450-500 *

yes no

Signature

Date:

By submitting this application I certify that the answers in this application are true and correct.

PLEASE BE AWARE WE ARE AN ALL VOLUNTEER ORGANIZATION . APPLICATIONS DO TAKE 48-72 HOURS FOR RESPONSE AT TIMES. WE DO OUR BEST TO RESPOND IN A TIMELY MANNER.

THANK YOU FOR YOUR UNDERSTANDING .

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LUNA SIBERIAN HUSKY RESCUE ADOPTION APPLICATION

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information