LIFE Dog Rescue Home-Check Checklist
This form is a home-check checklist in which is completed by an APPROVED LIFE Dog Rescue volunteer/LIFE Crew member. This form is ONLY for applicants who have applied to adopt a LIFE Rescue dog and have been approved to adopt.
Date Of Home Visit *
MM
/
DD
/
YYYY
Time
:
Name of Applicant *
Name of person who applied
Your answer
Name of Home Visit Volunteer/LIFE Crew Member *
Your answer
All residence of the home are to be present for the Home Visit? *
Are children (if present) respectful of pets (your observation)?
How do family members react to each other? *
Your answer
Is the main caretaker physically able to care for dog? *
Describe the street. *
Describe the setting. *
Condition of the garage Hazardous items? *
Poisonous plants? *
Are there stairs? *
What type of flooring do they have? *
Required
Are there lots of small objects or knick-knacks at dog level? *
Are living quarters dog friendly? *
Briefly Explain
Your answer
Is there a yard? *
Condition of the yard. *
Briefly Describe
Your answer
Is the yard fenced in? *
Are there any areas of gates or fence where a toy dog can slip out of dig under to escape?
Do they have a pool/pond/stream/lake in their yard? *
If yes, how do they plan to keep their animal secure from drowning?
Briefly Explain
Your answer
Where will the animal eat – is it a clean area? *
Your answer
What kind of food will the animal eat? *
Your answer
What foods are they currently using for other pets? *
Your answer
Where will the animal relieve its self? *
Your answer
Where will the animal sleep? *
Your answer
How will the animal get exercise? *
Your answer
Will they allow the animal on furniture? *
What will they do if the animal becomes very ill? *
Briefly Explain
Your answer
How will they work through behavioral issues? *
Your answer
Are pets well cared for? *
Required
What if their current pet(s) and adopted rescue animal don’t get along, what will they do? *
Your answer
Does the applicant have any concerns about the rescue animal? *
Your answer
Volunteer/LIFE Crew Member *
Additional Comments?
Your answer
I agree that all information above is truthfully stated to the best of my knowledge *
Volunteer/LIFE Crew Member Signature-Type Name below
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy