Lifehouse Animal Refuge and Rehabilitation

Name of animal you are applying for?

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What is your Name and Full Address?

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Do you Own or Rent?

Own
Rent

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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?

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How long have you lived at your current residence?

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Do you have a fenced yard?

Yes
No

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What is the best Phone Number to reach you at?

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What is your Email Address?

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What is your Occupation?

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Please list everyone currently residing in your home and include ages if under 21 years old.

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Is anyone at the address above allergic to animals?

Yes
No

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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

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Are you looking for an:

Check all that apply

Indoor Pet
Outdoor Pet

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What Characteristics are you looking for in a pet?

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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

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Will your pet be allowed to stay outside unsupervised when you are not at home?

Yes
No

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How many hours per day will your pet be left home alone, and where will he/she be kept during that time?

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Where will your new pet sleep at night?

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What if your new pet is not housebroken?

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Will you be practicing crate training or using another method?

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How will you react if your new pet chews up something they are not supposed to?

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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?

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What kind of food will your new pet eat?

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Will you take your pet to the vet for annual exams and vaccinations?

Yes
No

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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

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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

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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

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Did you know that it can cost $500.00 or more to properly care for your pet a year?

Yes
No

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Have you ever sold, given away, or surrendered you pet to a shelter, if so please explain?

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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

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List all animals currently or previously in the household. If they are no longer there please explain why

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Are your current animals:

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What would you do if your pet required life saving medical treatment but you did not have the funds to pay for it?

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Please list your current or previous veterinarian & their phone number

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For our reference check please list 2 NON-family members and their phone numbers

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Has anyone in your household ever been charged or convicted of domestic violence, child abuse, or animal cruelty?

Yes
No

This is a required question

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

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How will you handle the situation if your newly adopted pet snapped at you or someone else?

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How will you handle the situation if your newly adopted pet does not get along with your existing pet/s in the beginning?

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Are you willing to take your new pet to obedience classes?

Yes
No

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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

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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

This is a required question

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

This is a required question

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

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Why have you chosen to rescue a dog rather than buy from a pet store or breeder?

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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

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