*Full Name

*E-mail Address (**REQUIRED**)

*Home Address

*City State Zip Code

*Home Phone Number

*Do you have a fenced yard? Yes No
       -If yes, what type of fence?
       -What is the height?
       -Does the fence have a gate? Yes No
       -Is the perimeter of the yard where the dog will be completely surrounded by the fence? Yes No

*Do you have children in the house? Yes No
       -If yes ages

*Have you ever owned a dog before? Yes No
        If yes, what breed(s) and where is/are the dog(s) now?
       

*Have you ever owned a Siberian Husky before? Yes No
   -If no then have you taken the Husky Profiler to see if a Husky is the right dog for you? Yes No

*Do you have any other dogs? Yes No
       -If yes what type?
       -Age
       -Gender
       -Any Alpha Tendencies?
       -Is/Are your current dog(s) neutered/spayed? Yes No

*Do you work Full-Time Part-Time Home Most Of The Time ?

*How many hours will the husky be left alone on a daily basis on average? 0 1 2 3 4 5 6 7 8 9 10+ Hours

*Will your husky be Indoors Outdoors Both Indoors and Outdoors

*Where will your Siberian be kept during the day while you are away from home?

*Where will your Siberian sleep at night?

*Who will assume primary responsibility for the care of your Husky?

*Do you have time to play with and walk your Siberian Husky on a daily basis? Yes No Sometimes

*Are you willing to take your Husky to the vet for yearly vaccinations or when it is sick or injured? Yes No Maybe

*Are all family members in agreement about adding a new family member to the household? Yes No

*Do you feel the Siberian Husky is the right dog for you and your family? Yes No

*Do you understand that a Husky can not ever be allowed off leash, unless it is within a fully fenced-in, secure area? Yes No

*Do you understand that a Husky must not be left alone in a non-secure yard or area, and that they are notorious "escape artists"? Yes No

*Do you understand that a Husky must never be left alone while tethered, even if it is an attempt to keep it from escaping a yard? Yes No

*Do you understand that a Husky will shed its under coat at least twice a year, has a proclivity for digging, and is a passonate runner? Yes No

*Why do you want a Siberian Husky?

*What reasons do you feel might cause you to return a Husky adopted from us?

*Please use this space to add any additional comments or expand on any of the above questions.

*Please provide at least one personal reference (include name, phone number, and relationship to you; no family members):

*Please use this space to add any additional comments or expand on any of the above questions.

Please indicate your preferences in a Husky:
   Age:
   Gender: Either one Male Female
   Colors:

Would you consider a Husky mix? Yes No

Lastly, please let us know how you heard about Polaris Siberian Husky Rescue: Newspaper ad Website/Internet Search Word of Mouth (e.g., friend, family) Referred by Shelter Other

Submit this form? No Maybe Yes (**Select YES to Submit Form**)