Carmona Kennels
Breed: Siberian Husky | Member Since 9/12/2007
PUPPY/DOG ADOPTION CONTRACT
The information you provide in this application helps us to determine which Siberian personality will best match your home. Please fill out this entire application to the best of your knowledge. This application MUST be completed and submitted by an ADULT member of the household.
You will receive an email within 2-3 days of receipt of your application at the email address provided.
Indicate the time frame you had in mind for adopting a Siberian Husky. _________________________________________________
Why have you selected this time frame?
________________________________________________________
Contact Information
Primary Applicant
First name: _____________________ Last Name: ____________________
Occupation: ________________________________________________________
Age (if under 18): ________________
Street Address: ____________________________________________________ City: _____________________ State: _______________ Zip: ____________
Work Phone: ____________________ Best time to call: ________________
Home Phone: ____________________ Best time to call: _______________
Email: ____________________________
Co-Applicant
First name: _____________________ Last Name: ___________________
Occupation: _______________________________________________________
Age (if under 18): ________________ Email: ________________________
REFERENCES
Reference 1
First name: _____________________ Last Name: ____________________
Relationship ____________________ Phone: _________________________
Best time to call: __________________________________________________
Street Address: _____________________________________________________ City: __________________ State: ________________ Zip: _______________
Email Address: ______________________________________________________
Reference 2:
First name: _____________________ Last Name: ____________________
Relationship ____________________ Phone: _________________________
Best time to call: _________________________________________________
Street Address: ____________________________________________________ City: ____________________ State: ______________ Zip: _____________
Email Address: ______________________________________________________
Pet Ownership
Have you ever owned a Siberian Husky or Siberian Husky Mix? Explain.
_____________________________________
If you have owned a Siberian Husky or mix, please describe your experience below:
______________________________________________________________________
Breed Research
Have you done any research on the breed? Yes No
If yes, put a check by all that apply
I have read Book(s) about the breed ________
I have done research on the internet ________
A family member owns a Siberian Husky. ________
A friend owns a Siberian Husky. ________
I have talked to other people who own Huskies. ________
If you have indicated that you have done research, please describe: ___________________________________________________________________
Cat Ownership
Do you currently own cats? Yes No
If yes, please list: _________________________________________________
Have you own any in the past? Explain where they are now. ______________________________________________________________________
Past Dog Ownership
(If you have never owned dogs, please proceed to the next portion of the application)
How many dogs have you owned in the past 10 years?___________________
Briefly describe what happened to the dog(s) you no longer have:
______________________________________________________________________
Current Canine Ownership
(If you do not currently own any dogs, please proceed to the next portion of the application)
How many dogs do you currently own?
0 1 2 3 4 5 6 7 8 9 10 More than 10
If you currently have dog(s) please indicate the sex, age, and breed for each dog:
Dog's Name: ______________________________________
Sex: Male _____Female_____ Age: ___________ Breed: ____________
Dog's Name: ______________________________________
Sex: Male _____Female_____ Age: ___________ Breed: ____________
Other Pet Ownership
Do you currently own any other animals? Yes No
If yes, please list: _________________________________________________
Veterinarian Information
Do you have a regular veterinarian? Yes No
Vet Reference
First name: __________________ Last Name: __________________________
Organization: _________________________ Phone: ______________________
Adoption Information
Why have you chosen a Siberian Husky?
______________________________________________________________________
Energy level preference: What energy level do you prefer in a dog?
______________________________________________________________________
Why do you want a dog?
______________________________________________________________________
Do you want to adopt a male or female? Male _____ Female ______
If you have a preference in the sex of the dog you wish to adopt, please explain your reasoning: ______________________________________________________________________
Age preference and why: ____________________________________________
Personality & Behavior preferences: Please tell us the type of personality you would like in a dog.
______________________________________________________________________
If you are interested in a specific Siberian Husky displayed on the web site, please indicate which one(s): ______________________________________________________________________
Are you looking at other breeds of dogs? If so please indicate which breeds and what draws you to those breeds: _____________________________________________________________________
Place of Residence Information
Do you own or rent your home? _______________________________________
Do you live in a condo/town home or any other type of community association? ________________________________________________________
If you live in a community association or rent, is there breed or weight limit restrictions? __________________________________________
What are the restrictions, please describe: _____________________________________________________________________
If renting, do you have the landlord's permission to keep a dog?
Does not apply Yes No
How long have you lived at this address? ____________________________
Do you have any future plans of moving? No Yes
If you move, what are your plans for this dog if you adopt?
_____________________________________________________________________
Do you have a fenced-in yard? Yes No
If yes, please specify ______________________________________________
If other, please describe: __________________________________________
If no fence, how will you handle exercise and toilet duties:
If no fence, do you plan to fence in the yard? Yes No
If planning to fence in the yard, when do you plan to do so? ______________________________________________________________________
If planning on installing a fence, please specify height ______________________________________________________________________
Occupants and Ownership Information
How many adults are in your household? __________________________
How many children (under 18) are in your household? _______________
Please indicate the ages of all children: ___________________________
Who will be the primary caregiver for this dog(s)? __________________
Age of primary caregiver (if under 18): ____________________________
Is everyone in the household aware of and agreeable to your interest in adopting? Yes No
Have your children been taught how to appropriately interact with an animal? Yes No
Given the Siberian personality for escaping and roaming, will you teach all household members the importance of never taking the dog out without a lead and the importance of making sure all gates and doors are secure? Yes No
Are there regular visitors to your home (human or animal) with which your new dog must get along? Yes No
Please describe: _____________________________________________________
The New Puppy or Dog
Where will the dog spend the day? ____________________________________
Where will the dog spend the night? __________________________________
How many hours on average will the dog spend alone? __________________
Who will care for your dog(s) when you are on vacation? ______________
I/We hereby authorize through submission of this form, any veterinarian named above to release any information and records concerning my past or present care of animals to Carmona Kennels. and I do hereby agree to hold harmless and indemnify said veterinarian for providing such information.
I/We understand that shall the adoption/purchase not work out, for any reason, or the dog needs to be relinquished for any reason, the dog will not be given away, sold or put in a shelter but will be returned to Carmona Kennels.
I/We further understand that completing this application does not guarantee that a puppy/dog will be placed with me.
I/We certify by submission of this form that I have never been convicted of any violation of any ordinance or statute enacted pursuant to cruelty, neglect or abandonment of an animal.
I/We understand that owning a dog is a commitment for the dog's lifetime and if I adopt a dog from Carmona Kennels, I am willing to make that commitment. I Agree I Disagree
Names of applicant(s): _________________ ___________________
Signature(s): _________________ ___________________
Date: ___________________
By signing, you attest that all of the information you have provided in this application is true and correct.