Professional Development Workshop Registration Form

Full Name *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

E-mail *

How often do you check your emails? *

Occupation *

Primary Applicant must be over 21 years. Please specify your age *

Full Name

Email Address

How often do you check your emails?

How many adults currently live in your household? *

How many children currently live or regularly visit your household? *

What are their ages and exposure level to dogs? *

Have your children been taught how to appropriately interact with an animal? *

Is everyone in the household aware of and agreeable to your interest in adopting? *

What type of residence do you live in? *

House Unit Townhouse Acreage

Do you own or rent your residence? *

Own Rent

If you are renting do you have the landlord's permission to keep a dog?

Landlord reference: Organization - First Name - Surname - Phone - Email

Which council are you located in? *

Do you have any future plans of moving? *

Yes No Unsure

If you move, what arrangements will be made for this dog if you adopt?

How big is your yard? *

Small Medium Large

How high are your boundary fences and gates? *

Under 4ft 4ft 5ft Over 6ft No fencing

What are your boundary fences constructed of? *

Wood Wire Colour bond Other

Do you have a pool? *

Yes No

If so is it fenced and secure. *

Yes No

Have you ever owner a Siberian husky, Siberian Husky X or any Arctic Breeds? *

Yes No

If so, Please provide details.

Have you done any research on the breed? *

Yes No

Check all that apply. *

I have owned a Siberian Husky or Siberian Husky X I have done research on the internet A family member owns or has owned a Siberian Husky I have talked to people who own Huskies I have read Book(s) about the breed I have a friend who owns a Siberian Husky Other - if other please indicate what other research you have done. None of the above

Other *

Do you have any experience training and working with dogs with behavioural issues? Please give details. *

How many pets have you owned in the past 10 years?

Dog/Cat/Other?

Briefly describe what happened to any animals you no longer have.

How many cat’s do you currently own?

Are your cat(s) inside, outside cats or both?

Are your cat(s) declawed?

Has this cat ever interacted with dogs?

Please describe your cat’s interaction with dogs.

How many dogs do you currently own?

Name – Sex – Age – Breed

Has your dog been C5 vaccinated within the last 12 months?

Is your dog desexed? If not, is there a reason?

What is your dog's temperament, socialization and activity level?

Do you have a regular Veterinarian? *

Organization – vets name – phone number

Is this the vet you currently use?

Do you currently own any pocket pets/other animals? Please list how many and breed.

If you are interested in a specific dog on our website, please indicate which one(s)

If you have listed specific dog(s) you are interested in, please tell us one thing about each dog that sparks your interest

Why have you chosen a Siberian husky? *

Energy Level Preference *

Lapdog Quiet Adventurous High Energy Outdoorsy Athletic Sled Dog Low Energy

Why do you want a dog? Check all that Apply *

Companion Watch Dog Gift To breed Playmate for current dog For Kids Sled Dog Replace previous dog Other

Other

How much exercise will you be able to give your dog and how often? *

Please tell us what specific personality traits you are looking for in your new dog. *

Are you looking at other breeds of dogs? If so please indicate which breeds and what draws you to those breeds.

Do you plan on letting your dog off-lead in unfenced areas? *

Yes No

Are you prepared for regular grooming? *

Yes No

Please tell us what you know about the Siberian Husky breed. *

Where will the dog spend the day? *

Loose Indoors Crate Garage Loose Outdoors Tied Up Outside Kennel Run Other

If other, please describe.

Where will the dog spend the night? *

Loose Indoors Crate Garage Loose Outdoors Tied Up Outside Kennel Run Other

If other, please describe.

How many hours on average will the dog spend alone? *

Who will care for your dog(s) when you are on vacation? *

Please let us know any other information you wish us to consider in placing a dog with you. Here is your chance to personalize this application.

Where did you hear about us? *

Do you agree to let a representative of Homes For Huskies Rescue Inc. visit your home by appointment? *

Yes No

If No, why not?

I/We understand that EVERYONE IN THE FAMILY, INCLUDING OTHER PETS, MUST BE PRESENT AT HOMECHECKS AND THE POTENTIAL ADOPTION APPOINTMENT, NO EXCEPTIONS.

I/We hereby authorize through submission of this form, any veterinarian named above to release any information and records concerning my past or present care of animals to Homes For Huskies Rescue Inc. and I do hereby agree to hold harmless and indemnify said veterinarian for providing such information.

I/We understand that shall the adoption not work out, for any reason, the dog will not be given away, sold or put in a shelter but will be returned to Homes For Huskies Rescue Inc.

I/We further understand that completing this application does not guarantee that a dog will be placed with me.

I/We certify by submission of this form that I have never been convicted of any violation of any ordinance or statute enacted pursuant to cruelty, neglect or abandonment of an animal.

I/We will be asked to sign an adoption contract if a dog is placed with my family.

I/We understand that owning a dog is a commitment for the dog's lifetime and if I adopt a dog from Homes For Huskies Rescue Inc. I am willing to make that commitment.

*

I Agree I Disagree

By pressing the SUBMIT button, you attest that all of the information you have provided in this application is true and correct.

Please do not hit the SUBMIT button more than once. You will receive a confirmation page when your application has been processed.

If you have any problems submitting this form please email us and make sure you describe what happened. You can email us at adoption.homesforhuskiesrescue@gmail.com

Thank you for taking the first step towards giving a Siberian husky a new beginning.

Homes For Huskies Rescue Inc.

Primary Applicant Details

Co-Applicant Details

Your household

Breed Experience

Past Pet Ownership

Current Feline Ownership

Current Canine Ownership

Veterinarian Information

Adoption Information

The New Dog

Home Visit and Agreement