Do not hit ENTER on your keyboard or the application will be sent prematurely.
Your Full Name

Your Street Address

Your City, State, and Zip Code

Your date of birth

Home Phone

Cell Phone

Best time to call

Your E-mail address

Place of employment

Work Phone

Other adults residing in home

Please list children residing in your home by name and age

Is everyone in your home agreeable to having a pet?
Yes No Not yet

Who will be primarily responsible for the pet's care and training?

Does anyone in the household have any known allergies to animals?
Yes No 

If yes, please provide a brief explaination

Please provide the name, address, and phone number of the vet/vets you currently use, or used for your last pet

Please alert your vet office that we will be calling for a reference.

Is your home a:
Single family house Apartment Townhouse/Condo Other

Please explain if "other"

If you rent, is your landlord agreeable to your owning a pet?
Yes No Not applicable

Landlord's name and phone number (if you rent)

Are there any covenants or restrictions on pets where you live?
Yes No

If yes, please explain

Do you have a fenced yard or fenced area where a dog can safely run?
Yes No

Type and height?

If no, please explain how and where you will exercise a dog and allow it to relieve itself

Is there a dog park or a fenced area near you where dogs are allowed to run and exercise without being exposed to dangers?
Yes No

If you have a pool, is it fenced so that there is no danger of the pet gaining access to it without supervision?
Yes No I don't have a pool

Is someone normally home during the day?
Yes No

If not, how many hours will the dog be alone on a normal weekday?

Where will the dog spend the day?
Loose indoors Crate Basement Garage Fenced yard Tied up Kennel run (outside) Loose outdoors Doggie daycare Other

If "other", please explain

During the screening process for this application, you will be asked to receive a volunteer into your home to verify its suitability for a pet. Do you have a problem with this?
Yes No

If and when you travel, who will take care of the dog while you're away?

If you have children, are you willing to accept the additional responsibility of a rescue animal?
Yes No No children living with me

Are you willing to teach the children the proper treatment and handling of a live animal?
Yes No No children living with me

Are you aware that the large majority of rescue animals have experienced some trauma in their lives and are sometimes fearful?
Yes No

What breed are you interested in adopting?

Are you interested in a particular dog?
Yes No   The dog's name?  

Have you researched the characteristics of the breed that you are seeking to adopt?
Yes No

Do you truly feel this breed is right for your family?
Yes No

Why?

Have you carefully considered the financial cost of pet ownership, and are you financially prepared to give your pet the routine medical care it requires?
Yes No

Do you currently own one or more pets?
Yes No

Please describe all pets by breed, sex, age, how long owned, spayed/neutered

If you have a pet or pets now, have they all been spayed or neutered?
Yes No I don't currently have any pets

If not, please explain

Are all of your animals up to date on ALL vaccinations?
Yes No

If you own dogs, are they on regular heartworm preventative?
Yes No

Have you owned pets prior to any you may own now?
Yes No

Were any of these rescue animals?
Yes No

Have you ever trained one or more pets?
Yes No

Explain

Have you ever trained a pet in basic obedience?
Yes No

If you have owned pets in the past, please list them by name and breed and explain what happened to them

Of the pets that you own or have owned, what do you enjoy most about pet ownership?

What do you like the least?

Have you ever bred a pet?
Yes No

Have you ever bred animals for profit?
Yes No

If so, when?

Please describe the characteristics of the ideal dog for your family

Have you ever owned or personally met a rescue animal?
Yes No

Why do you want a rescue animal?

How did you learn about rescue animals?

How did you learn about Lighthouse Animal Rescue?

Are you willing to spend at least an hour or more a week brushing and grooming a pet (more if the pet gets wet or gets into burrs, etc.) especially when it is shedding?
Yes No

If a dog sheds heavily, is this going to present a problem?
Yes No

Are you willing to clean the ears and eyes of accumulated matter every single day if necessary?
Yes No

Are you willing to provide training to solve any behavior problems?
Yes No

Please provide the names and phone numbers of at least three people who can recommend you as a proper adoptive family for a rescued pet.

Please indicate any preferences you may have
Male Female Either sex

Would you prefer a:
Purebred Mixed breed No preference

Are you interested in a pet with special needs?
Yes No Depends on the need

If no, why not?

Are you aware that some rescue pets have been abused and/or neglected, and need extra attention?
Yes No

Are you willing to provide this extra attention?
Yes No

Comments, questions, or additional information?

The Lighthouse Animal Rescue is a non-profit organization working to ensure the continued welfare of all animals by rescuing, rehabilitating, and placing them in loving, caring homes.
We do not sell animals, nor do we purchase animals.
To continue our work we do ask for a donation to the Lighthouse Animal Rescue.
You will be asked to sign an adoption contract which requires, among other things, that the dog be returned to Lighthouse Animal Rescue immediately should you no longer be able to keep it. It may not be sold, transferred or given to any individual or establishment.
In the unlikely event that the animal is unaltered, you are required to have it spayed/neutered within thirty (30) days of adoption.
The dog must be kept on heartworm preventative.
Under no circumstances is the dog to be bred.
You are also required to take the dog to a veterinarian within three (3) days of the date of the contract for a check-up and any necessary medical treatment.

All of the information I have given in this questionnaire is true and complete. Should a rescue animal be placed with me, it will reside in my home as a pet. I agree to provide the dog with adequate food, water, shelter, affection and medical care. I understand about the temperament, habits and physical condition of the pets available for adoption. The Lighthouse Animal Rescue is in no way liable or responsible for any damage, accident or injury from the placement of a dog into my household.

Applicant's signature:    Date: