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Husky Havoc RRT Application for Adoption Page 1 Go to Page 2
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Primary Applicant:
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First Name:
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Last Name:
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Gender:
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Male
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Female
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Street address:
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City:
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State:
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Zip Code:
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Student
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Currently unemployed
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Occupation:
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Age:
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How many hours do you work a week?
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Primary phone:
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Secondary phone:
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Best time to call:
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Fax:
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Email:
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Type of car: Use the Ctrl key to select more than one option
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Type of dog restraint in car: Use the Ctrl key to select more than one opti6n
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Co-Applicant:
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First Name:
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Last Name:
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Gender:
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Male
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Female
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Age:
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Relationship to Primary Applicant:
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Occupation:
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Student
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Currently unemployed
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How many hours do you work a week?
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Phone:
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Best time to call:
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Email:
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Type of car: Use the Ctrl key to select more than one
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Type of dog restraint in car: Use the Ctrl key to select more than one option
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Personal References: please choose no more than 1 family member
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Relationship to Primary applicant
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Residence Information:
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Neighborhood:
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How long have you lived at your current home address?
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Type of home:
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Do you rent or own?
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Rent
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Own
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Do you plan to move in the near future?
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Yes
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Uncertain
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No
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If/when you move, what are your plans for the dog?
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Landlord Information (if applicable):
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Name
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Company, if applicable
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Phone Number
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Do you have your landlord's permission to keep a dog?
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Not yet
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Yes
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Yes, but with restrictions
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If your landlord has restrictions (i.e., size, number, breed, etc) please specify:
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Do you have a fenced yard?
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No
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Yes
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I don't have a yard
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If you do have a fence, what type? Use the Ctrl key to select multiple options
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Does the fence run underground as well?
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No
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If you chose Other fence type, please specify here:
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Yes
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If you don't have a fenced in yard, how do you plan to handle your dog's exercise and toilet regimes? please explain in detail
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Are you aware that Northern Breed dogs tend to roam and cannot find their way back to you? Are you aware that they can't be trusted off-tether unless in a securely fenced yard? Are you aware that they can jump fences under 6' and can dig their way out from underground? Please check the box to acknowledge that you have read these statements:
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Members of your household: please list any additional people who will be living in the house with the dog
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Name
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Age, Gender
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Relationship to primary applicant
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Check here if this person will be helping to care for the dog
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Is everyone in the household aware of your interest in adopting a northern breed dog?
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Yes
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Not yet
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Check this box if everyone in the household has given permission to adopt a northern breed dog.
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If you have children under age 18, have they been taught how to properly approach and handle a dog?
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Yes
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Not yet
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Don't see a need, they know
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Are you aware that dogs can perceive a child's approach as a threat if the child has not been taught how to properly approach a dog? Please check the box to acknowledge that you have read this.
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Current Pet Information: Cats and Other Animals:
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Do you currently own any cats?
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No
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Yes
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Are you planning on owning a cat (or taking in an additional cat) in the near future?
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No
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Yes
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Uncertain
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Are you aware that northern breeds have high prey drives and must ALWAYS be supervised when interacting with smaller animals including cats and toy breed dogs? Are you aware that even a trained husky can see smaller animals as prey? Please check the box to show you've read this.
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How many cats have you lived with in the past5 years?
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Please briefly describe what happened to the cats you no longer own:
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How many cats do you currently own?
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Are any of your cats declawed?
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No
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Yes, front and back
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Check here if your cats are spayed/neutered.
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Yes, front only
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