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HOMEWARD BOWND

Offering a caring refuge for Siberian Huskies until their 'forever' home can be found.

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Adoption Application
Adoptable Huskies
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Adoption Application Form

Interested in (dog's name)

Name(required)

Email(required)

Phone

What is the best time to reach you?

Mornings Evenings Weekends

Address

Rent or Own?

If you rent, may we contact your landlord?

Yes No N/A

If yes, please provide landlord's contact info

If no, please explain

Who are the other humans that live at this residence and how old are they?

How many animals live at this residence?

Animal #1

Outdoor Indoor Both

Kind of Animal 1

Age 1

Sex 1

Male Female

Spayed/Neutered 1

Yes No

How long have you had #1

Where did you get animal #1?

Breeder Rescue Other

Contact Info #1 (phone, address, email)

Animal #2

Outdoor Indoor Both

Kind of Animal 2

Age 2

Sex 2

Male Female

Spayed/Neutered 2

Yes No

How long have you had #2

Where did you get animal #2?

Breeder Rescue Other

Contact Info #2 (phone, address, e-mail)

Animal #3

Outdoor Indoor Both

Kind of Animal 3

Age 3

Sex 3

Male Female

Spayed/Neutered 3

Yes No

How long have you had #3

Where did you get animal #3?

Breeder Rescue Other

Contact Info #3 (phone, address, email)

Who will be the primary caregiver for this animal?

Would this animal primarily be

Indoor Outdoor Both

Do you have a fenced in yard?

Yes No

If yes, how high is the fence?

What is the fence made of?

How many hours would the dog be left alone each day?

How often would this dog be exercised?

Will this dog be attending obedience training?

Yes No

If yes, who will be doing the training?

What type of training methods do they use?

What veterinarian would this dog see? Name and Contact information of Veterinarian to be used (Name, Address, and Phone)

If you go on vacation or are away for a day or more who will care for this dog? (Family, Neighbor, Boarding House, Veterinarian)? Please explain

If this dog were to bite someone what would you do? Please explain in detail

Have you ever had to euthanize an animal?

Yes No

If yes, please explain the circumstances

Please list 3 personal references: **(Cannot be: anyone that lives in your household, veterinarian, or previous rescue/shelter)**. Reference #1 (Name, Address, Phone)

Reference #2 (Name, Address, Phone)

Reference #3 (Name, Address, Phone)

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By submitting this form, I acknowledge that I have read the first two pages of information in this document.

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Hours & Info

23520 - 317th St,
La Motte, IA 52054

563-223-8148

By appointment only

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