Name___________________________________________________________________________________

Address_________________________________________________________________________________

Phone Number(s)__________________________________________________________________________

Have you ever owned a Siberian Husky?        Yes        No

Why do you want a Siberian Husky?

List all dogs owned in the past five years and where they were obtained.

Do you still have the dogs mentioned above?  If not, what became of them?

List all other pets you have right now.

Describe the area where your Siberian Husky will live. 

Do you have a fenced yard?    yes    no        Do you have a 24” x 36” crate?    yes    no

Do you    Own?        Rent? 

If you rent, please list the landlord’s name and phone number:_______________________________________

            You will have to provide written permission from the landlord.

What gender and ages are the people in your household?

Do you understand that a Siberian Husky is a high energy dog that loves to run, needs a lot of exercise, and can become destructive if bored        Yes    No

Do you understand that a Siberian Husky can NEVER be trusted off-leash?        Yes        No

Please list three references, their addresses, phone numbers, and e-mail addresses.  Please include your vet if applicable.

1.

2.

3.

Signed________________________________________________________    Date ____________________

Signed________________________________________________________    Date ____________________