Wait List Information Sheet

In order to better match your interest in a rescue Siberian Husky, we ask that you fill out the following questionnaire, which we will maintain.

Name Referral
Home Telephone Work Telephone
Approximate ages of family members
If married, does your spouse approve of you getting a dog?
What dog(s) have you owned previously?
Reason you no longer have dog(s)
Why do you want a Siberian Husky?


Are you familiar with the characteristics and temperament of a Siberian Husky?
What qualities do you like in a Siberian Husky?


Have you ever been convicted of animal cruelty?
Have you ever been convicted of violating animal control laws?
Do you have a fenced yard? Height of fence and any gates?
How many dogs are living with you now? Breed and sex?
Are your dogs spayed/neutered?
Do you have cats or other animals?
Have you taken your dogs to obedience class?
Are you willing to obedience-train your Siberian Husky?
Will you permit a Rescue volunteer to visit your home?
How did you hear about the Rescue Program?


No Preference: ________________
Sex: Male:___________ 
Age: Puppy:__________
Coat/Eye Preferences: ________________ 
Other Requirements: ________________

I declare that the above is true to the best of my knowledge and ability. I understand that the completion of this form does not guarantee my receipt of a Siberan Husky.