ADOPTION APPLICATION
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PERSONAL INFORMATION
PRIMARY APPLICANT
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Email
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| Phone Number
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| Date of Birth
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| Occupation
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| Spouse's First and Last Name
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PERSONAL REFERENCES
(no relatives please)
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| First Reference: First & Last Name, Relationship, Phone Number.
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| Second Reference: First & Last Name, Relationship, Phone Number.
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| Third Reference: First & Last Name, Relationship, Phone Number.
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RESIDENCE INFORMATION
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| Type of Dwelling
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| How long at this address?
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| Your previous address if above is less than one year:
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| Do you?
| Own Rent
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| If you rent: Do you have your landlord's permission to have a dog?
| Yes Nlo
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| Landlord's First & Last Name
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| Landlord's Phone
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CONTAINMENT INFORMATION
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| Do you have a fenced yard?
| Yes No
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| If yes, check all that apply: Fence height(s)
| Under 4' 4' 5' 6' or more
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| Fence type(s):
| Chain Link Privacy Invisible Other
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| If you do not have a fenced yard: How do you plan to handle exercise and toilet duties?
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| Are you familiar with crating?
| Yes No
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| What do you think about crates?
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HOUSEHOLD INFORMATION
Provide the following for each person, other than applicant, who lives in your household:
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| #1. Name, Age, Relationship, Occupation
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| #2. Name, Age, Relationship, Occupation
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| #3. Name, Age, Relationship, Occupation
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| #4. Name, Age, Relationship, Occupation
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| More persons not listed above?
| Yes No
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| Dog's primary caregiver:
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| Has everyone above agreed to your pursuing the adoption?
| Yes No
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PET OWNERSHIP
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| Do you own any cats? If so, how many and have they interacted with dogs before? Briefly describe this interaction:
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| Have you ever owned or do you own any dogs? If yes, how many in the past 10 years? Briefly describe what happened to the dogs you no longer have:
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| How many do you own now?
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| For each dog you currently own, please provide the following information: Name, Age, Breed, Spayed/Neutered?
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| Do you have any other pets? If yes, please list all animals that you own (other than cats or dogs):
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VETERINARIAN INFORMATION
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| Do you have a veterinarian?
| Yes No
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| If yes, what is the name of vet, practice name, address, city, state and phone number?
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| Do you currently practice heartworm prevention? If yes, what medication do you use and how often? If no, please explain why not?
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THE NEW DOG
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| Where will your dog spend the day?
| Loose indoors Garage Outside in kennel run Tied up outdoors Loose outdoors Crate Basement Other
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| Where will your dog spend the night?
| Loose indoors Outside in kennel run Garage Tied up outdoors Loose outdoors Crate Basement Other
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| How many hours will your dog spend alone each day? Is there someone home during the day? What are your work hours? Who will care for your dog while you're on vacation?
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OTHER INFORMATION
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| Will you allow a representative of The Siberian Husky Emergency Life Line Fund to visit your home by appointment?
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| How did you hear about The SHELL Fund?
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| Is there any additional information that you want us to consider when evaluating your application:
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| You understand that owning a dog is a commitment for the dog's lifetime and that if you adopt a dog from The SHELL Fund, you are affirming that you are both willing and able to make that commitment and that you can responsibly and reliably ensure the safe
| Yes No
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Image Verification
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