Husky Havoc RRT Application for Adoption      
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Primary Applicant:
First Name:
 Last Name:
Gender:
 Male
 Female
Street address:
City:
 State:
Zip Code:
Student
 Currently
unemployed
Occupation:
Age:
 How many hours do you
work a week?
Primary phone:
 Secondary phone:
Best time to call:
 Fax:
Email:
Type of car:
Use the Ctrl key to
select more than one
option
Type of dog restraint in car:
Use the Ctrl key to select more than
one opti6n
Co-Applicant:
First Name:
 Last Name:
Gender:
 Male
 Female
Age:
 Relationship to
Primary Applicant:
Occupation:
Student
 Currently unemployed
How many hours do you
work a week?
Phone:
 Best time to call:
Email:
Type of car:
Use the Ctrl key to
select more than one
Type of dog restraint in car:
Use the Ctrl key to select more than
one option
Personal References: please choose no more than 1 family member
Name
Relationship to
Primary applicant
Phone Number
Email Address
Residence Information:
Neighborhood:
How long have you lived at
your current home address?
Type of home:
Do you rent or own?
 Rent
 Own
Do you plan to move in the near future?
 Yes
 Uncertain
No
If/when you move, what are your
plans for the dog?
Landlord Information (if applicable):
Name
 Company, if applicable
 Phone Number
Do you have your landlord's
permission to keep a dog?
 Not yet
 Yes
Yes, but with restrictions
If your landlord has restrictions (i.e., size,
number, breed, etc) please specify:
Do you have a fenced yard?
 No
 Yes
I don't have a yard
If you do have a fence, what type? Use
the Ctrl key to select multiple options
Does the fence run
underground as well?
 No
If you chose Other fence type, please specify here:
Yes
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
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:
Members of your household:
please list any additional people who will be living in the house with the dog


Name

Age, Gender

Relationship to
primary applicant
 Check here if
this person
will be
helping to
care for the
dog
Is everyone in the household aware of
your interest in adopting a northern
breed dog?
Yes
 Not yet
Check this box if everyone in the
household has given permission
to adopt a northern breed dog.
If you have children under age 18, have they been taught
how to properly approach and handle a dog?
Yes
 Not yet
 Don't see a need, they know
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.
Current Pet Information: Cats and Other Animals:
Do you currently own any cats?
 No
 Yes
Are you planning on owning a cat (or taking in an
additional cat) in the near future?
 No
 Yes
 Uncertain
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.
How many cats have you lived
with in the past5 years?
 Please briefly describe
what happened to the
cats you no longer own:
How many cats do you currently own?
Are any of your
cats declawed?
 No
 Yes,
front and back
Check here if your cats
are spayed/neutered.
Yes,
front only
Where do your cats live?
 If outdoor only, where
do your cats find shelter?
Use the Ctrl key to make
multiple selections
Briefly describe how each
of your cats have related
to dogs in the past:
Do you have other small animals (i.e., rabbits,
ferrets, hamsters, etc.). Please specify type and
number of that type that you own:
Where do your
small animals live?
 Briefly describe how
each of your small
animals have related to
dogs in the past:
Do you have a safe area in your home
or outdoors on your property where
your cats and/or  small animals can
escape a husky if they need to?
 No
 Yes, indoors only
Yes,
outdoors
only
 Yes, both indoors
and outdoors
Have you ever lost, surrendered to a
shelter/rescue, re-homed or given a
cat or small animal away?
No
 Yes.
Please
describe:
Do any of your cats or small animals have
characteristics or concerns (either health
or behavioral) that HHRRT should be
aware of?
Do you have any other animals (i.e., birds, reptiles, horses, farm animals)?
If so, please list them here:


Type of Animal

How
many  
do you
own?
Check here
if that
animal will
interact
with the dog
Does this animal
live indoors, free
outdoors, or in a
barn?
Who is the primary caregiver for
these animals? Check all that apply
 Primary
applicant
 Co-applicant
Other
household
member(s)
 Third party
(i.e., employees,
volunteers)
Veterinarian & Other Canine Care Concern Information:
Do you currently have a
veterinarian who
regularly sees your pets?
 No, I don't
take my
animals to
a vet
 No, I have
no other
pets
Not now,
but I did
in the past
5 years
Yes, see
info below
Vet's Name
Vet Clinic's Name
Phone Number
How long have you
been a client there?
If you would prefer that Husky Havoc RRT NOT contact your vet, please check this box
Do you currently have an obedience
trainer for your dog(s)?
No, I do all
of the training
myself
 No, I don't do
obedience training
with my dogs
 Yes, see
info below
Trainer's Name
Company / Organization Name
Phone Number
Has this person
helped you
train dogs in the past?
If you would prefer that HHRRT NOT contact your trainer, please check this box
Are you aware that northern breed dogs are notoriously difficult to train? Are you aware
that without obedience training, huskies can: become destructive, wander off, and have
other inappropriate behaviors? Please check this box to acknowledge that you've read this.  
How do you intend to handle the dog's grooming needs?
I will groom the dog myself
as often as necessary
 I will take the dog to a professional
groomer as often as necessary
Are you aware that northern breed dogs tend to shed profusely and require weekly
grooming? Are you aware that they loose their entire undercoat 2x a year and require daily
brushing during this time? Are you aware that you should NEVER shave a husky because
their coats protect them in the summer too? Please check the box to acknowledge that you've read this.
Pet sitter in our home
What will you do for the dog
when you go out of town?
Boarding kennel
Leave the dog at home
alone with plenty of
food and water
Dog always comes
with me when I
leave home
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