Siberian Husky Placement Application

We're sorry - you forgot to fill out all of the required information in the form. Please correct the items which appear in red below and then resubmit the application. If you continue to encounter difficulty with this form, please contact the with your problem.

Your Information:
Your Name*:
Address*:
City*: State*:
Phone*: Email*:
Phone 2:
Dog's Information:
Dog's Name*: Sex*:
Coat Color*: Eye Color*:
Weight: lbs.Age*: years months
Breeder: Has the breeder been contacted?
Dog's Health:
Is the dog up to date on vaccinations?*
Has the dog been tested for heartworm within the past year?*
Does the dog need any special care?*
If yes, please explain any medical issues:
Other Information:
Is the dog good with cats?*: Good with young children (under 8)?*:
Good with small dogs?*: Good with older children?*:
Good with large dogs?*: Is the dog housebroken?*:
Primary housing has been*: Has the dog ever bitten anyone?*:
If the dog has ever bitten anyone, please explain circumstances:
Reason dog is being given up:
To help us better network your dog, please write a description about your dog that you feel will give potential adopters a better profile of your dog's personality and nature. Include things like whether the dog is crate-trained, how he/she rides in the car, how you would describe his/her personality (shy, outgoing, couch potato, energetic), whether the dog is obedience trained, and so on.
How did you hear about us?
Please select the amount you are contributing to PSHR as a surrender application fee (a minimum non-refundable $10 fee is required):
By checking this box I verify that the above information is true to the best of my knowledge, that I own or am responsible for the care and placement of the above mentioned dog, and understand that I cannot ask an adoption fee for any dog placed in the PSHR program.
Enter the letters/numbers in the box below to proceed: