questionnaire

We at Rustic strive to ensure that all of our Siberians and their new families are truly happy
together. Therefore, we require all prospective buyers to fill out this questionnaire. Please
understand that each individual puppy/dog placement is determined according to that specific animal's
personality and by the role that he/she will play within his/her new family. We want our Siberians to
have only the best homes possible and to live happy and healthy lives. We trust, that as a dog lover,
you too can appreciate this. Our ultimate goal is that our puppies/dogs becomes a permanent member
of his/her family and that he/she has the best chance of living as an active family member.

Contact Information

Name (s) :

Street :

City / State / Zip :

Country :

How long at address :

Home Phone :

Work Phone :

Cell Phone :

(please include area codes for the above numbers)

e-mail Address :

Personal Information

Marital Status :

What are your living arrangements?

Ages of all household members?

Your Occupation?

Spouses Occupation?

If there was a change in the relationship who would the dog live with?

Residence Information

What type of residence do you live in?

What type of setting do you live in (city, country, etc)?

Do you own or rent your home?

If renting, can you supply us a letter of permission for pets from the landlord?

Does your insurance company provide coverage for owning a siberian husky?

Do you have a fenced yard?

If yes, please describe with height?

If no, do you plan on installing one or how
would you exercise your
siberian....please explain in detail.

Household Information

Are there any Children in the home? If so, list sex & ages.

Child 3

Child 4

Child 1

Child 2

Has there ever been an issue with your child and an animal in the past?

If yes, please explain in detail.

Does everyone in the household agree on adding a siberian to the family?

Does everyone in the household agree that this siberian would be an active family member and
is to be treated with dignity and respect?

Where would the dog reside (inside, outside, etc.) Please explain.

Do you believe in crating and would you be willing to crate the dog at bedtime or during
times when it will be left alone?

On an average day, how many hours will the dog be left alone?

Does your lifestyle allow for scheduled feedings, exercise, obedience class, etc?

Where would this dog go should you suddenly become ill or go on vacation and unable to
care for him?

Pet Ownership Information

Have you ever owned a Siberian Husky?
If yes, tell us about him/her, pet or breeding, etc.
And Finally, what happened to them?

Do you currently own a Siberian Husky or
other breed of dog? If yes, tell us about
him/her, age, characteristics, breed, etc.

Is your current pet(s) spayed/neutered?
If no, do you plan on doing it?

Are your currenet Pet(s) current on vaccinations?

Are your current Pet(s) screened yearly for Heartworm Disease?

Are your current Pet(s) receiving monthly Heartworm Preventative?

If you have never owned a Siberian, have you thoroughly researched the breed?

Do you understand that a Siberian Husky can NEVER be trusted off leash
regardless of training?
If no, please explain.

Do you understand the strong prey drive of the Siberian Husky and
their potential to injure and even kill small animals such as rabbits,
squirrels, cats and sometimes even small toy dog breeds?

Do you agree that Siberians make very poor guard dogs :-) ?

Are you familiar with the containment requirements of a
siberian husky and of their "escape artisit" expertise?

Are you familiar with the "landscaping" abilities of a
siberian and their passion for digging?

Are you familiar with the amount of exercise required for a Siberian?

Do you understand the social needs of a siberian husky?

Are you confident and willing to meet these needs of a siberian
husky for the next 12-15 years for the entire life of the dog?

What qualities are you looking for in a Siberian Husky?

What qualities are you not willing to live with?

Why do you want a Siberian Husky?

Have you ever had to re-home, give away or relinquish a pet to a shelter?
If yes, please explain.

Your Puppy / Dog Interest

Please tell us the type of puppy/dog you are looking for (check all that apply) :

Adult (under 5 years)

Young Puppy (under 6 months)

Older Puppy (6 mths - 1 year)

Adult (5+ years)

Prefer Puppy but would consider an adult

What sex do you prefer....male, female or no preference?

We do NOT breed for specific coat or eye color.
Do you have a preference in this area ?

If yes, what is your preference?

Would you consider something different if your preference is not available?

Please tell us your plans for this dog.......companion pet,
breeding, mushing, skijoring, etc.

References

Please provide us with your veterinarians business name, address, city,
state, zip & phone number

Please provide us with 2 non-related references. Supply
Name/Address/Phone & e-mail address if available

Our Requirements

All of our Siberians are sold by contract only. We do this to protect the dog and assure our buyers
that we stand behind all dogs bred by Rustic.

Would you agree to signing a contract?

We require that all buyers provide us with a check made payable to the American Kennel Club at the time of purchase ($15).
Together we will complete the puppy/dog AKC registration application and/or transfer paperwork and will have the new
registration certificates mailed directly to you, the buyer. For record keeping purposes we require the buyer to provide us with a
copy of the new registration certificate upon receipt from the AKC.

Would you agree to the AKC Registration portion of our contract?

We require all of our buyers to have CERF (eye) exams done on their Rustic Siberian at 1, 2 and 3 years of age and to provide us
with copies of all exam reports. We will gladly advise you of upcoming CERF clinics in your area which are done at reduced cost,
usually $25. If you choose to OFA (hips) it is a one time procedure and must be done after 2 years of age. This is our way of
monitoring two very important health related aspects of our breeding program.

Would you agree to the CERF exams and foward the reports to us?

We strongly recommend that all puppies attend puppy obedience class (oftentimes referred to as "puppy kindergarten"). This
helps with socialization and learning manners in a structured setting. It is also a very positive way for a puppy and his/her hew
owner to bond and sets the stage for living in harmony with one another. We offer a $50 rebate upon completion of the 8 week
kindergarten class. In addition, we offer $25 for each additional 6-8 week obedience class thereafter up to $100 (4 additional
sessions beyond puppy kindergarten).

Would you be willing to fullfill the puppy kindergaten recommendation?

If no, please explain

All dogs sold as companion pets are required to be spayed/neutered by 5 months of age. All adults are spayed/neutered prior to
going to their new homes. Your AKC registration application will be held until a signed letter from your veterinarian , on your
veterinarians stationary, is received stating that the spay/neuter is complete. All AKC registration papers will have the
non-breeding (limited registration) boxes checked prior to submission to AKC.

Do you agree to our spay/neuter requirements?