Siberian Husky Placement Application

Fill out the following form to apply to place a dog in our rescue program. All of the information you give us will then be used to help match your dog with an appropriate adopter. Starred (*) fields are required.

The following are requirements for all dogs accepted into our program. If your dog does not meet these qualifications please contact us for further help.

  1. AKC papers are not required, but the dog must be a purebred siberian husky.
  2. You must be the owner or temporary guardian of the dog to use this online submission form.
  3. You must not be asking an adoption fee for the dog.
  4. The dog cannot have bitten a human being before or have any serious aggressive tendencies.

Please note that there is a minimum non-refundable $10 fee required for all dogs accepted into the program. After submitting the following form a rescue volunteer will contact you within a few days. Once your dog is accepted into the program this fee will need to be sent to us before your dog can be matched with potential adopters or listed on our website.

To apply by mail please click here to download a PDF application.


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: