About You :
Your Name:
Your e-mail
address:
Your complete
Mailing Address:
(include city and state)
How long
have you lived at this address?
If less than
2 years, please provide previous address:
(include city and state)
Your Home Phone
Number:
Your Occupation:
How did you
find us?
Medical :
Your Vet Clinic's
Name and Location:
Your Vet Clinic's
Phone Number:
May we call
your vet for a reference?
(Please include phone no. above!)
Yes
No
Household :
Describe
your Household Members (and ages of children):
Describe
your home location:
(choose one)
Rural
Suburban
Urban
Your
Home Setting:
(choose one)
House
Apartment
Townhouse
Mobile Home
Duplex
Condominium
Other (specify)
Do you Rent
or own?
Rent
Own
If you rent,
do you have your landlord's permission to have a dog?
Yes
No
If
so, please provide landlord's name and phone number so that
we may verify this:
Describe
your fenced area:
(materials, size, height, flooring)
What
is the height of all gates?
Are
the gates normally locked?
Yes
No
Do
you have a pool?
Yes
No
If
you do have a pool, is it fenced separately from the yard?
Yes
No
Is
there any history of allergy or asthma in your family?
Yes
No
Your Dogs :
Describe
your current pets (plus non-dogs) - Name, breed, size, age,
sex, pack position:
Are
your current pets spayed or neutered?
Yes
No
Describe
dogs in past - Name, breed, size, age, sex, pack position,
how long you had them:
What happened
to the dogs you no longer have?
Has your current
dog ever lived with other dogs before?
Yes
No
How
will you introduce the new dog?
Do you have
cats?
Yes
No
Where,
what, and how are your dogs fed?
Siberian Huskies :
Describe your experience with
northern breeds:
The New Dog :
Why do you
wish to purchase this dog or puppy?
(check all that apply)
House pet
Showing in Conformation
Breeding
Companion for other pet
Protection for home/family
Watchdog
Companion for family
Companion for children
Protection for business
As a gift
Black and white
Gray and white
Sable and white (red and black)
Red and white
All white
Doesn't matter
Eye
color preference(s)?
Blue
Brown
Bi-eyed (one of each)
Parti-eyed (two colors, one eye)
Doesn't matter
Which
sex do you prefer?
Male
Female
Doesn't matter
What
characteristics MUST the dog absolutely have?
Housebroken
Pre-School Children (Less than 5 years old)
School-Age Children
Teenage Children
Senior Adults in the Home
Gets along with Cats
Gets along with small dogs
Gets along with large dogs
Other (specify)
How
many hours each day will the dog be outside?
How
many hours each day will the dog be inside?
How
many hours each day will the dog be left alone?
Where
will the dog be left when alone?
What
area(s) of the house will the dog be allowed into?
Where
will he sleep?
Does
everyone in your family want a dog?
Why
do you want a Siberian Husky?
What
other breeds (if any) are you interested in?
Explain
shedding:
If we recommend
a training class, will you go?
Yes
No
How would you
train this dog? (Check all that apply)
Obedience school
Hit with newspaper
Hand signals
Firm verbal commands
Click and treat
Food reward
Other (specify)
Would you
be willing to let us visit your home?
Yes
No
Will you
be able to live with hair on your furniture, stains on your
rugs, a warm body on your bed, and an animal that might
be destructive at times?
Yes
No
Pets are
an investment of time and money. Can you afford to provide
medical care, grooming, proper diet, proper shelter and
exercise for your new pet?
Yes
No
Are you able
to make a long-term committment to care for your pet for
it's entire lifespan, which could be as much as 12-16 years?
Yes
No
Under what
circumstances would you not be able to keep this dog?
What would
happen to the dog if you moved:
Locally?
Out of state?
Out of the country?
Miscellaneous :
What
would you do if your dog got lost?
Where
is the nearest animal shelter?
What
will you do if the dog marks in the house?
Will you buy
a crate?
Yes
No
I am aware that :
Pet dogs and
puppies are sold with a limited AKC registration and must
be spayed/neutered.
Yes
No
Aniak Siberians
may do a phone interview, vet reference check, and home/fence
check before and after you take your dog or puppy home.
Yes
No
Siberian Huskies
can NEVER be trusted off leash.
Yes
No
Siberian Huskies
are known for killing livestock and small animals.
Yes
No
Siberian Huskies
do not make good guard dogs.
Yes
No
Please let
us know any other information you wish us to consider in
placing one of our Siberian Huskies with you - here is your
chance to personalize this application <G>.
I understand
that completion of this application does not guarantee that
I will be offered a dog or puppy for purchase, and that
Aniak Siberians is under no obligation to provide me with
a puppy. This application becomes part of our contract.
Yes
No