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