S.H.E.B.A. FOUNDATION

Personal Information:
Name:		Referral:
Address:
Home Ph:		Work Ph:
Family Information:
Approx Ages of Family Members:
If Married does Spouse approve of getting a dog?
What dog(s) have you owned previously?
Reason for no longer having dog(s)?
Why do you want a Siberian Husky?
Are you familiar with the characteristics and temperament of a Siberian Husky?
What qualities do you like in a Siberian Husky?
Have you ever been convicted of animal cruelty?
Have you ever been convicted of violating animal control laws?
Do you have a fenced Yard? Height of Fence and any gates?
How many dogs are living with you now? Breed and Sex?
Are your dogs spayed / neutered?
Do you have Cats or other Animals?
Have you taken your dogs to obedience class?
Are you willing to obedience-train your Siberian Husky?
Will you permit a Rescue volunteer to visit your Home?
How did you hear about the Rescue Program?

Preferences for Dog:
No Preference:
Sex:
Age:
Coat / Eye Preferences:
Other Requirements:
By sending this via electornic Mail, I delare that the above is true to the best of my knowledge and ability. I understand that the completion of this form does NOT guarantee my receipt of a Siberian Husky, and that I later may be asked to sign in person a copy of this report: