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SIBERIAN HUSKY RESCUE Page: 3


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Western Maine Siberian
Husky Rescue

Adoption Application
--------------------------------------------------------------
For your convenience we have provided an
Adoption Application for you to
print and fill out prior to your visit. Your answers to this application help find the best possible match between you and a Siberian in our care.
The more we know about you the better we are able to make each adoption successful.

Name of dog to be adopted: Date:

Name:__________________________

Address:________________________________________City:______________State___________Zip___________

Home phone( )_________________

Occupation:____________________
Spouse Occupation:______________________________

Referred by:____________________________
Refrences: 1)_____________________________2)_____________________________
phone #1)______________ #2)_________________

Veterinarian:__________________

Vet's Address:__________________________________phone #________________________

1. Type of dwelling: House (rent/own)__________Condo_____Apt______

2. Do you have fencing_______type_______________dimensions including height:________________

Are you willing to comply with the rescues fencing or leash policy?_________ Comments:_______________________________________

3: Why do you want a Siberian Husky____________________________________________________________

4. Have you ever owned a dog?__________________

Breed:______________________Age:____________When:_______________________________________

5. Other animals? Please list type, age ,sex:_____________________________________________________________________________

6. Have you ever given up a dog before ? Y/ N Why ?______________________________________________

7. Children, and ages:________________

8. Allergies:___________________________________

9. Where will the husky be kept during the day?_______________At night:____________________

How many hours will the dog be alone?_______ Is someone home during the day?_____________

10. Are you willing to take the dog to obedience class if necessary?_________

11. Sex, color, or age preferences?__________________________________________

In order for you to adopt a husky from this program it is
necessary for you to have personal interview with one of our volunteers.
The purpose is acquaint you with the breed and its' traits


Signed_________________________



Date:__________________________

Donation : ______________________

If under 18, you must have a parent or guardian sign his/her approval.
____________________________________________________________________________________________________________________



Kim Baker / 1359 Bear river Rd, Newry , Maine, 04261/ (207) 824-2679/ bearrvr@megalink.net

Rescue Web site : members.tripod.com/siberianhuskyrescue/siberiahuskyrescue/