Home Visit

Name*
eMail Address*
Cell Phone:*
Street Address
Suite | Apt or Unit Number
City*
State/Province*
Zip/Postal Code
Country
Names of other adults in home:
Names & ages of children in home:
APPLICANT’S NEIGHBORHOOD
Describe Street:
Describe Setting:
APPLICANT’S HOME
Describe the condition of home:
Are there a lot of steps?
Are living quarters dog friendly?
Will they allow the dog to have free run of house?
How will they prevent the dog from escaping their house?
Any poisonous plants?
Will the dogs have access to basement?
Is there anything on the floors that the dog could get into?
Is the trash put away that the dog cannot get into?
EXERCISE/FENCED AREA
Is there a fenced yard?
Type and height:
How and when will fenced area be used?
Is the area directly accessible from the house?
Is the fenced area secure and ready for use?
Is it easily opened by children? Are locks present and secured?
APPLICANT’S ATTITUDE
How were you welcomed?
If there were children present how did they act?
Which family members were present?
Is everyone in family in agreement over adopting this dog?
Does applicant believe that new dog will “train” old dog or vice versa?
In what family activities will the dog be included?
FAMILY SETTING
Describe behavior of adults among themselves, and to any other pets or children:
How does adopter interact with current pets if any:
Explain that re-homing a dog is stressful for the dog. That the rescued dog that they want to adopt may have potty accidents, even if they are housebroken while they are in fostercare, for the first few weeks. Ask adoptor what would they do or how would they react to their new dog having accidents.
If children present, ask what they would do if one of their kids or their friends was teasing the dog?
Would you feel comfortable leaving your dog with the applicant?
COMMENTS
Comments:
EVALUATOR
Name
First Last
Phone Number:
Date
MM
DD
YYYY
Would you Approve?*
- Yes
- No
Signature

Home Visit

APPLICANT’S NEIGHBORHOOD

APPLICANT’S HOME

EXERCISE/FENCED AREA

APPLICANT’S ATTITUDE

FAMILY SETTING

COMMENTS

EVALUATOR

State Resources

Lizzie’s Story

– Melissa Alfonso