Pet Harbor Rescue & Referral, Inc.
. . . a port in the storm located in Virginia for homeless Siberian Huskies and cats. . .

(703) 583-HSKY
adopt@petharbor.org

Process
Home
FAQ
Dog Adoption Application
If you are applying to adopt a DOG, this is the right application.
If you are applying to adopt a CAT, go to Cat Application.

However, if you want to adopt a DOG and have adopted from Pet Harbor Rescue before, click here for an abbreviated application.
If you want to adopt a CAT and have adopted from Pet Harbor Rescue before, click here for an abbreviated application.

Please note: If you submit an application & don't hear from us within 48 hours, please write webmaster@petharbor.org.


Congratulations for having the desire to adopt a homeless pet. This is our application, not a contract to adopt. As noted on the Adoption Process page, this is the first step in the process. A successful adoption depends on finding the perfect pet for you & the perfect permanent home for the pet. So please be as complete & honest as possible. We apologize the application is long, but it is necessary to get as much information as possible to make the right match. When finished, submit the form online, mail, or fax.
NOTE! (1) WE RESERVE THE RIGHT TO VISIT THE HOME WHERE THE DOG WILL LIVE PRIOR TO ADOPTION
(2) WE RESERVE THE RIGHT TO APPROVE OR DENY ANY ADOPTION FOR ANY REASON AND THE RIGHT TO NOT DISCLOSE THE REASON
(3) YOU MUST BE AT LEAST 18 TO APPLY
(4) ALL HUMAN AND CANINE MEMBERS RESIDING IN THE HOME MUST MEET THE DOG PRIOR TO ADOPTION AND
(5) ALTHOUGH WE DO NOT DEFINE A GEOGRAPHIC TERRITORY, WE GIVE PREFERENCE TO LOCAL ADOPTERS. ALSO, ALL ADOPTERS HAVE TO COME TO US (USUALLY THE FREDERICKSBURG, VA AREA) TO MEET/ADOPT THE DOG. THAT INCLUDES ALL HUMANS & CANINES RESIDING IN THE HOUSE.
Do you understand and agree to the above notice? Yes No
When answer choices are offered, please check all that apply. Please be as specific as you can.
Basics:
1. Has anyone in your house ever been convicted of an animal-related charge? Yes No
2. What date are you prepared to take a dog home? Please do not apply until a week or less before you're ready.
3. How did you find out about us?
4. If you are simultaneously applying to adopt at other rescue organizations, what are the organizations' names?

Before you answer the following questions, please familiarize yourself with our adoption procedures and our contract requirements.

5. Do you understand donations are tax-deductible and are not refundable? Yes No
6. What is a method of payment for the donation that Pet Harbor will not accept?
7. What is the minimum donation amount required to adopt the particular dog you want to adopt?
8. Per the contractual requirements, what must you do with the dog if can no longer keep him/her?
9. How long are you required to keep in touch with us and keep your contact information current with us?
10. Do you object to volunteers investigating and/or inquiring concerning the dog's circumstances after adoption? Yes No
About You:
Your first and last name
Street address
City State Zip Code
Mailing address if it is different from the above
What county (county, not country) do you live in?
If anyone in the house has an occupation that involves animals in any way, what is it?
Home phone Cell phone
Your work phone Other resident adult work phone
E-mail
About Your Family:
1. How many adults live in the house?
2. First and last names of other adult residents in the house
3. How many people under age 18 live in the house?
4. What are the ages of those under 18?
5. What is the first name of the dog's primary caregiver?
6. Age of primary caregiver if under 18?
7. Is everyone in the household aware of and agreeable to your adopting a dog? Yes No
8. Is anyone in the house allergic to any animals? Yes No Unsure
8. If you answered "Yes" or "Unsure," how will you avoid allergic reactions?
About Your Home:
1. Type of home: 2. Home setting: 3. How long have you lived at this address?
4. If you have a property owners' association, what are the restrictions it has regarding (a) pets and (b) fences?
5. If you sometime have to move where dogs are not allowed, where will this dog go?
6. If anyone in the home is in the armed forces, what are your specific plans for your pet if that person is deployed?
7. Do you have a fully fenced-in yard? Yes No 8. If yes, what is your fence height at its lowest point?
9. If you have no fence, do you plan to fence in the yard? Yes No Undecided
10. What type of fence do you have? 11. What type of flooring?
12. In acres or portion of an acre, how big is the fenced area?
13. If your fencing proves to be inadequate, how many times a day will you walk the dog & for how long each time?
14. Do you have an indoor dog crate? Yes No 15. If not, would you be willing to buy and use one? Yes No
16. Do you have a doghouse? Yes No 17. Do you have an outdoor dog kennel? Yes No
18. Do you have future plans to move? Yes No 19. If yes, how soon?
20. Do you: Own Rent Live with family Other
21. Landlord's name: 22. Landlord's phone number:
NOTE: If you rent, we will verify you can have this dog. Also we require you have written permission to have this pet. We will need that permission faxed to us.
References:
Veterinarian
If you have no current veterinarian, please list your most recent vet, no matter where located or how long ago.
Name
Phone

Please list people who know your experience with animals. At least one must be your relative. Do not put people who live in your house.
Reference #1
 Name Relationship Phone E-mail
Reference #2
 Name Relationship Phone E-mail
Reference #3
 Name Relationship Phone E-mail
Siberian Husky Experience:
Has anyone in your household ever been owned by any of the following?
Siberian Husky Husky mix Neither Both Other Northern Breed
What did you learn about Siberian Huskies from reading Pet Harbor's description of the Siberian Husky?
What traits do you like about the Siberian Husky?
What traits do you dislike about the Siberian Husky?
Pet Ownership:
Has anyone in your household owned any cats in the past 5 years you no longer own? Yes No If yes, please fill in the "Previous Cat Ownership" section below.
Has anyone in your household owned any dogs in the past 5 years you no longer own? Yes No If yes, please fill in the "Previous Dog Ownership" section below.
Are there cats currently living in your home? Yes No If yes, please fill in the "Current Cat Ownership" section below.
Are there dogs currently living in your home? Yes No If yes, please fill in the "Current Dog Ownership" section below.
What brand of heartworm preventative do you use currently?
Previous Cat Ownership (GO BACK FIVE YEARS ONLY. ONLY list pets for which YOU (or someone currently residing in your house) was financially responsible. Do not list pets you as "growing up" or that were "family pets."):
Prior Cat #1
Prior Cat #2
Prior Cat #3
Prior Cat #4
Name Name Name Name
Breed Breed Breed Breed
Gender FM Gender FM Gender FM Gender FM
How long did you have this cat? How long did you have this cat? How long did you have this cat? How long did you have this cat?
Where is this cat now? Where is this cat now? Where is this cat now? Where is this cat now?
If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death?
In whose name are this cat's vet records? In whose name are this cat's vet records? In whose name are this cat's vet records? In whose name are this cat's vet records?
Previous Dog Ownership (GO BACK FIVE YEARS ONLY. ONLY list pets for which YOU (or someone currently residing in your house) was financially responsible. Do not list pets you as "growing up" or that were "family pets."):
Prior Dog #1
Prior Dog #2
Prior Dog #3
Prior Dog #4
Name Name Name Name
Breed Breed Breed Breed
Gender FM Gender FM Gender FM Gender FM
How long did you have this dog? How long did you have this dog? How long did you have this dog? How long did you have this dog?
Where is this dog now? Where is this dog now? Where is this dog now? Where is this dog now?
If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death?
In whose name are this dog's vet records? In whose name are this dog's vet records? In whose name are this dog's vet records? In whose name are this dog's vet records?
Current Cat Ownership:
Current Cat #1
Current Cat #2
Current Cat #3
Current Cat #4
Name Name Name Name
Breed Breed Breed Breed
Gender FM Age Gender FM Age Gender FM Age Gender FM Age
How long have you had this cat? How long have you had this cat? How long have you had this cat? How long have you had this cat?
Is this cat spayed or neutered? Yes No Is this cat spayed or neutered? Yes No Is this cat spayed or neutered? Yes No Is this cat spayed or neutered? Yes No
If not, why not? If not, why not? If not, why not? If not, why not?
Is this cat declawed? Yes No Is this cat declawed? Yes No Is this cat declawed? Yes No Is this cat declawed? Yes No
Has this cat interacted with medium or larger dogs before? Has this cat interacted with medium or larger dogs before? Has this cat interacted with medium or larger dogs before? Has this cat interacted with medium or larger dogs before?
Yes No Yes No Yes No Yes No
Does this cat go outdoors? Yes No Does this cat go outdoors? Yes No Does this cat go outdoors? Yes No Does this cat go outdoors? Yes No
In whose name are this cat's vet records? In whose name are this cat's vet records? In whose name are this cat's vet records? In whose name are this cat's vet records?
Current Dog Ownership:
Current dog #1
Current dog #2
Current dog #3
Current dog #4
Name Name Name Name
Breed Breed Breed Breed
Gender FM Age Gender FM Age Gender FM Age Gender FM Age
How long have you had this dog? How long have you had this dog? How long have you had this dog? How long have you had this dog?
Is this dog spayed or neutered? Yes No Is this dog spayed or neutered? Yes No Is this dog spayed or neutered? Yes No Is this dog spayed or neutered? Yes No
If not, why not? If not, why not? If not, why not? If not, why not?
Does this dog sleep indoors? Yes No Does this dog sleep indoors? Yes No Does this dog sleep indoors? Yes No Does this dog sleep indoors? Yes No
Is this dog indoors when you are gone? Yes No Is this dog indoors when you are gone? Yes No Is this dog indoors when you are gone? Yes No Is this dog indoors when you are gone? Yes No
In whose name are this dog's vet records? In whose name are this dog's vet records? In whose name are this dog's vet records? In whose name are this dog's vet records?
Other Pets:
If there are any other types of pets in the household or currently on the property, such as hamsters, ferrets, birds, reptiles, livestock, please list the types.
Of those, with which ones will the dog have contact?
About the Dog You Want to Adopt:
If there is a particular dog you are interested in, what is that dog’s name? Applying for a particular dog doesn't mean you will be approved for that dog. We will work with you to try to make the right match. Another dog might be better suited for you.
What about this particular dog sparks your interest?
Are you interested only in that dog, even if you would be approved for only a different dog? If yes, skip down to "Other Information." Yes No
Must the dog be purebred? Yes No What gender(s) are acceptable to you? Male Female Either
If you have a gender preference, please explain why.
Youngest acceptable age?
Oldest acceptable age?
If you have an age preference, please explain why.
What eye color is acceptable to you?
Any Blue Brown Bi-eyed Parti-Eyed (blue & brown in same eye) Other

What coat colors are acceptable to you?
Any Black & White Grey & White Red & White Solid White Other

What plans do you have for this dog?
Companion Pet Obedience Agility Exercise Hiking Mushing Water Sports Other

Please explain how important it is to you that the dog already have the following traits before he/she first gets to your house.
1. Housebroken Doesn't matter I can train him to do this. I prefer he already be. Absolutely must already be!
2. Crate-trained Doesn't matter I can train him to do this. I prefer he already be. Absolutely must already be!
3. Nondestructive so I can leave him running free in my house when I am not home Doesn't matter I can train him to do this. I prefer he already be. Absolutely must already be!
4. Be good with babies Doesn't matter I can train him to do this. I prefer he already be. Absolutely must already be!
5. If the dog escapes, he will come to me when I call him/her. Doesn't matter I can train him to do this. I prefer he already will. Absolutely must already do!
6. Won’t pull when walked on a leash Doesn't matter I can train him to do this. I prefer he already won't. Absolutely must already!
7. Knows basic commands Doesn't matter I can train him to do this. I prefer he already does. Absolutely must already!
8. Won’t jump up on people Doesn't matter I can train him to do this. I prefer he already won't. Absolutely must already!
9. Quiet dog when humans are not home Doesn't matter I can train him to do this. I prefer he already is. Absolutely must already be!
10. Won’t dig Doesn't matter I can train him to do this. I prefer he already won't. Absolutely must already!
11. Rides well uncrated in the car Doesn't matter I can train him to do this. I prefer he already can. Absolutely must already!
12. Can safely take dog to dog parks Doesn't matter I prefer he already can. Absolute must!
13. Has no medical issues Doesn't matter Preferred Absolute must!
Other Information:

Please understand since we don't know you, these answers are all we have to try to match you with a dog. The more explanatory, the better.
How much do you think it will cost you to care for this dog for one year? $ Can you afford it? Yes No
If some catastrophic thing happens, such as your dog accidentally gets out and gets hit by a car and the veterinarian tells you "He'll be fine, but it will cost thousands of dollars to fix," financially how will you handle it? PLEASE BE SPECIFIC. NOTE: We are NOT asking about the moral dilemma. We are ONLY asking specifically how you would handle it FINANCIALLY.
What plans do you have for training? We want to know what specific methods you will employ, not just who will train the dog & not what commands you will teach.
How will you discipline your pet if he does something you want to correct?
How will you handle the dog marking his territory inside the house?
How will you handle the dog eating a hole in furniture or chewing up something valuable?
How will you handle finding a potty accident you did not see the dog have?
There is NO perfect dog. Just like humans, dogs make mistakes. For example, a housebroken dog might go back to being not housebroken or the dog may get so attached to you he develops separation anxiety. If the dog you adopt makes mistakes after he comes to your house, what will be your course of action?
What will you do if after adoption, this dog does not get along with your current pets? If you have cats, what will you do if the dog tries to harm the cats? What if there are fights with your current dogs & this dog?
How many hours will this dog be alone (without humans) during the day? Will your dog be tied outside? Yes No
If yes, what type of tieing mechanism? What is the maximum length of time tied?
Where will the dog be when you are not at home? Where will the dog sleep?
Who will care for the dog when you vacation?
If you decide you no longer want the dog, what will you do with him/her?
Have you considered any health problems or risks to which you may be exposing your current pets? Yes No

The word "you" in the next 3 questions applies to all adults residing in the house.
Has anyone in your household EVER released or returned a pet to an animal shelter or rescue organization? Yes No
Has anyone in your household EVER given away a pet? Yes No
Has anyone in your household EVER sold a pet? Yes No
If yes to any of the last 3 questions, what were the circumstances?
How many months per year will you keep your dog on heartworm preventative?
Comments:
Please let us know any other information you wish us to consider in placing a pet with you. Here is your chance to personalize this application.
Your interest is deeply appreciated because every dog or cat we can place is one less that is homeless, hungry, abused, or killed.
If we do not have the pet you are looking for, would you like us to contact other rescuers on your behalf? Yes No
By indicating yes and submitting this form, I signify that all information given in this application is true and correct, to the best of my/our knowledge. And by indicating yes and submitting this form, I hereby further grant consent to Pet Harbor and its volunteers to seek information about me from all named and unnamed sources within this application, including but not limited to veterinarian, rental agent, personal references, to assist in the application process. Yes No
PET HARBOR WOULD LIKE TO THANK YOU FOR TAKING
THE TIME TO COMPLETE THIS APPLICATION.
Good Dogs and Cats Deserve Second Chances