Lifehouse Animal Refuge and Rehabilitation
Application to Adopt an Animal
* Required
Name of animal you are applying for?
*
Your answer
What is your Name and Full Address?
*
Your answer
Do you Own or Rent?
*
Own
Rent
If you rent, Please list your landlords name and phone number. (If you don't rent please just put NA)
*
Does your landlord approve of you adopting a pet?
Your answer
How long have you lived at your current residence?
*
Your answer
Do you have a fenced yard?
*
Yes
No
What is the best Phone Number to reach you at?
*
Your answer
What is your Email Address?
*
Your answer
What is your Occupation?
Your answer
Please list everyone currently residing in your home and include ages if under 21 years old.
Your answer
Is anyone at the address above allergic to animals?
*
Yes
No
What would you do if someone in your household developed an allergy to your new pet?
*
Please select all that apply
Get rid of the animal ASAP
Return it to the rescue
Discuss allergy medication options with your doctor
Put the animal outside
Just live with it
Required
Are you looking for an:
*
Check all that apply
Indoor Pet
Outdoor Pet
Required
What Characteristics are you looking for in a pet?
*
Your answer
Where will your new pet spend most of its time?
*
Please check all that apply
Inside the house
Outside in a fenced yard
On a chain
In an outdoor dog kennel
Required
Will your pet be allowed to stay outside unsupervised when you are not at home?
*
Yes
No
How many hours per day will your pet be left home alone, and where will he/she be kept during that time?
*
Your answer
Where will your new pet sleep at night?
*
Your answer
What if your new pet is not housebroken?
*
Your answer
Will you be practicing crate training or using another method?
*
Your answer
How will you react if your new pet chews up something they are not supposed to?
*
Your answer
If you ever had to move, what would you do with your pets?
*
What would you do if you had to move and the new place to live does not accept pets?
Your answer
What kind of food will your new pet eat?
*
Your answer
Will you take your pet to the vet for annual exams and vaccinations?
*
Yes
No
Will they be given monthly heartworm pills and flea/tick prevention? If so, what brand?
*
Heartworm prevention is so important, as Tennessee is a High Risk state. Flea/Tick prevention is also very important as Tennessee has both this insects and they can transmit disease and parasites to your pets
Your answer
Did you know that your pet needs to have their ears and nails trimmed regularly? Will you do this or take them to the vet/groomer?
*
Please check all that apply
Take to vet/groomer for Regular nail trimming
Take to vet/groomer for Ear Cleanings
I can clean the ears and trim the nails at home
Required
If your pet has long hair how do you plan on maintaining it so that it does not become dirty and matted?
*
Please check all that apply
Regular visits to the groomer
I can maintain my pets hair at home
Required
Did you know that it can cost $500.00 or more to properly care for your pet a year?
*
Yes
No
Have you ever sold, given away, or surrendered you pet to a shelter, if so please explain?
*
Your answer
Have you ever adopted a pet through a shelter or other rescue organization? Is so, please the shelter's name and phone number.
*
If you have not adopted a pet before, please put NA
Your answer
List all animals currently or previously in the household. If they are no longer there please explain why
*
Your answer
Are your current animals:
*
Spayed
Neutered
Up to date on all shots
On heartworm prevention
On Flea/Tick control
Required
What would you do if your pet required life saving medical treatment but you did not have the funds to pay for it?
*
Your answer
Please list your current or previous veterinarian & their phone number
*
Your answer
For our reference check please list 2 NON-family members and their phone numbers
*
Your answer
Has anyone in your household ever been charged or convicted of domestic violence, child abuse, or animal cruelty?
*
Yes
No
Did you know that it may take days, weeks, or even months for your newly adopted pet to become adjusted to their new environment?
*
Yes
No
How will you handle the situation if your newly adopted pet snapped at you or someone else?
*
Your answer
How will you handle the situation if your newly adopted pet does not get along with your existing pet/s in the beginning?
*
Your answer
Are you willing to take your new pet to obedience classes?
*
Yes
No
Do you understand that if for any reason you feel that the pet you adopted is not working out, that it is to be returned to this organization no questions asked with a non-refundable adoption donation?
*
Yes
No
Do you understand that if for any reason during your pets lifespan, other than the immediate recommendation of your veterinarian, you feel that he/she needs to be humanely euthanized, that we are to be contacted prior to doing so?
*
Yes
No
How would you best describe what you are looking for in a new pet?
*
Please select all that apply
Just a dog for your kid
A guard dog
A new member of the family, like having another child
A dog is a dog, not a family member
Required
If you are not local, are you willing to pick up your new pet or pay to have your new pet safely transported?
*
Yes
No
Why have you chosen to rescue a dog rather than buy from a pet store or breeder?
*
Your answer
By my/our signature/s below, I/we acknowladge that we have carefully read the entire application and have answered all the questions truthfully to the best of my/our knowledge. I understand that if I falsified any information on this application, no further consideration of adoption will be given to me at any future date by this rescue. By signing this application I also give the rescue permission to contact the above references. If this application is completed via email it is hereby agreed and acknowledged that my/our typed signature will be binding as if hand written.
*
Please put your first and last name in the box provided if you agree
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
Forms