First Name*

Last Name*

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City*

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Southern Siberian Rescue Adoption Application for a Rescue Siberian Husky Southern Siberian Rescue (SSR) would like to thank you for your interest in our foster dogs and turning to rescue for your next family member. That foster dog will be forever grateful and appreciative of your patience and understanding during our review process. We will appreciate your answers to the following questions so that we may work with you in finding the best fit for your family and your existing pets. You may feel the application is long but we only ask these questions to learn more about you and your pets so we can match you with the right foster dog and vice versa. Submission of this application does not mean that you will receive a dog. All information is treated as confidential. INCOMPLETE APPLICATION IS REASON FOR REFUSAL. We are all volunteers trying to help our foster dogs and will do our best to process your application in a timely manner. Our review process is very stringent, including vet references, personal references, a home check and your understanding of the breed. Please save us some time and be sure your vet information is current and correct before submitting your application. Please review your application for accuracy and complete information prior to submitting.

I understand that completing an application does not mean that I will be able to adopt a dog from SSR.*

I understand that a rescue dog has already suffered the loss of at least one family. I will support SSR's efforts in facilitating that the next home is a permanent one by allowing SSR to: (1) Interview me and talk to my personal references. (2) Discuss my current and previous pets and their care with my veterinarian. (3) Schedule a visit to my home to inspect fences and other areas where the dog will live. *

I understand that a dog rescued through SSR must be kept within a fenced yard, on a leash or in my home at all times.*

The dog may not be chained, staked or unattended outside at any time.*

I understand that as of January 1, 2019 there will be an adoption fee of $350.00 for the dog, which will be used to offset the veterinary expenses incurred by SSR.*

I understand that all rescue dogs are spayed or neutered before adoption. A rescue dog will not be bred.*

I am able to afford regular (at least annual) veterinary care, heartworm preventative and flea and tick preventative for the dog.*

I am prepared for emergency medical care, if needed.*

Spouse's Name:

Employer*

Employer Address*

Primary Veternarian Clinic*

Veterinarian Phone*

1. Are members of the family home during the day?*

If so, who?

2. List all people living in the house. Please include age and relationship.*

3. Does any household member suffer from asthma or allergies?*

If yes, please describe:

4. Have you or anyone in your household ever been convicted of a felony? *

If yes, please explain:

5. Have you or anyone in your household ever been charged or convicted of animal cruelty, neglect or abuse? *

If yes, please explain:

6. Have you or anyone in your household ever surrendered any animals in lieu of prosecution? *

If yes, please explain:

7. Do you live in a house, condo, apartment, trailer, other?*

8. Do you rent or own?*

9. If you rent, please provide name and phone number of Landlord. Please have copy of lease agreement available if needed.

17. Is the property fenced?

If so, what type of fence?

What is the height of your fence at its lowest point?

1. Do you have any pets currently?*

If yes, please list the Name, Age, Sex, Species and Breed of each pet in your home: Required if you answered yes.

2. Are your pets current on vaccinations (DHLPP)

3. Rabies?

4. Heartworm Preventative?

5. Altered (Spay and/or Neutered)?

If not spay or neutered, why?

6. How much do you think the yearly maintenance of a dog is?*

7. Please tell us about your pet’s temperament(s) and personality so that we may better match one of our foster dogs with your existing pets.

Please give directions to your home from a major highway. Please note that we are based out of Raleigh, NC so complete directions will be appreciated. *

Your signature authorizes SSR to contact your references and verify all information provided to us on this application. Please realize any inaccurate or incomplete information can be reason for refusal. SHOULD YOUR APPLICATION BE APPROVED, THIS DOCUMENT WILL BE PART OF YOUR ADOPTION CONTRACT. MISREPRESENTATIONS IN THIS APPLICATION DISCOVERED AFTER ADOPTION OF A DOG FROM SSR COULD RESULT IN THE IMMEDIATE FORFEITURE OF THE DOG. Your Name:*