Patriot Siberian Husky Rescue

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.

AKC papers are not required, but the dog must be a purebred siberian husky.
You must be the owner or temporary guardian of the dog to use this online submission form.
You must not be asking an adoption fee for the dog.
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.

Patriot Siberian Husky Rescue does not have a facility where dogs can be surrendered. We have VERY limited foster homes and not all dogs can be accepted into foster care. We cannot offer temporary foster. All parties filling out the surrender application MUST be the legal owner. If immediate surrender is needed, you should contact your local Animal Control Officer or shelter. Surrendering owners may not require or receive any money from Patriot or the adopter. Any listed Siberian may not be listed anywhere else such as Craiglist. Patriot volunteers do not inspect adopter's homes but surrendering owners may choose to do so. Surrendering owners are expected to meet on neutral ground with prospective adopters such as a park, walking trail etc. You are encouraged to wait at least 24 hours after meeting an adopter before surrendering. Surrendering owners are to supply adopter with vet records, transfer of ownership paperwork and microchip information. Dogs will not be posted until the $10.00 fee is paid and pictures are provided.

I have read, understand and comply with the above statements.

You will be able to comeback to this form on the same computer and browser and the info you have filled in will be automatically entered again for you.

Basic Information

Dog's Name*

Is the dog a Siberian husky mix or a cross breed of a Siberian husky?

Sex*

Coat Color*

Eye Color*

Weight
lbs.

Age*
years months

Is the dog microchipped?
Yes No

Are there any actions, suits, investigations, or proceedings pending or threatened against the dog, whether civil, criminal or administrative?
Yes No

Are there any outstanding judgments, decrees or orders of any governmental body against or affecting the dog?
Yes No

Current Owner & Breeder Information

Owner Information

Your Name*

Address*

City*

State*

Zip Code*

Home Phone*

Cell Phone*

Email*

Which number should we call?*

Best time to reach you?

Are YOU the legal owner of the dog and have paperwork that supports that (vet record in your name, dog license etc)
Yes No

How long have you owned the dog?

Breeder Information

Dog's Health

Vet Info

Date of last vet visit?

Do you have vet records for as long as you have owned the dog?*
Yes No

Is the dog up to date on vaccinations?* Yes No

Heartworm Info

Has the dog been tested for heartworm within the past year?*

Date of last heartworm
preventive given?

Brand of heartworm
preventive given?

Flea/Tick Info

Date of last flea and tick preventive given?

Brand of flea and tick preventive given?

Nutrition Info

Current brand of food?

Time(s) dog is being fed?

How many cups of food per meal?

Any food allergies? Yes No

Does your dog have a sensitive stomach? Yes No

Special Needs

Has your dog ever suffered an injury or had surgery?
Yes No

Does the dog need any special care?*
Yes No

About the Dog and Home Life

About Other Animals

Has your dog lived with cats/small animals?*
Yes No Unknown

Has your dog had exposure to cats/small animals?*
Yes No Unknown

Good with small dogs?*
Yes No Unknown

Good with medium to large dogs?*
Yes No Unknown

Good with male dogs?*
Yes No Unknown

Good with female dogs?*
Yes No Unknown

Has the dog ever bitten or killed another animal?*
Yes No

About Other People

Good with young children (under 9)?*
Yes No Unknown

Good with older children?*
Yes No Unknown

Has the dog ever bitten a human and broken the skin?*
Yes No Unknown

Does your dog have issue with male or female humans?*
Yes No Unknown

About the Home

Is the dog housebroken?*
Yes No Unknown

Has your dog been to doggie daycare or dog parks?
Yes No

Where does the dog stay when home alone?

Where does the dog sleep?

Where is the dog when you are home?

Has the dog ever escaped the home or secured outdoor area?
Yes No

What are some of your dogs favorite activities?

What kind of exercise and how often does your dog currently receive?

Why are you looking to re home your dog?

How long are you willing to wait to find the right permanent home for your dog?
1-4 weeks 1-3 months 3-6 months any, as long as the home is right

Are you on a deadline to re-home your dog? Yes No

If for any reason the placement of your Siberian does not work, are you willing to take possession of the dog until another placement can be found?
Yes No

Please provide us any additional information below and also provide the "ideal" new home for your dog

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.