Applicants:

Street address:

City:

State:

Zip:

1. Describe the street: Busy / Quiet / In-between

2. Describe the setting: Rural / Suburban / Urban

3. Is there a yard? Yes / No Type of Access? (Doggie door, etc)

4. Is the yard fenced? Yes, fully / Yes, partially / No

5. Describe the fence and gate(s): (height, type, condition, type of latch)

6. Describe any hazards in the yard (swimming pool, spa, shrubs, etc) or around the outside of the house (electrical wiring, cables, etc.) and how the dog will be protected from them:

7. Describe the condition of the home, for example, in good repair, clean, neat:

8. Describe the basement, for example, in good repair, clean, neat, no debris on floor, hazardous substances out of reach of dog:

9. Will the dog have access to the basement? Yes / No / NA

10. Describe the garage, for example, in good repair, clean, no debris on floor, hazardous substances out of reach of the dog:

11. Will the dog have access to the garage? Yes / No / NA

12. Describe other pets and their behavior:

13. Describe the behavior of adults to you, among themselves, and to any other pets or children---respectful, hectic, loud, quiet, commanding, etc.:

14. Describe behavior of children in relation to adults, to other children and to any pets:

15. Any special needs, unusual circumstances or concerns that we should consider:

16. Would you feel comfortable leaving your dog with the applicant? Explain:

17. Where will the dog sleep?

18. Will the dog be crated and for how long?

19. What will the dog be fed?

20. Adopter ready for the transition period? (Diarrhea, separation anxiety, etc.)? Yes / No

21. Who will be the main caregiver?

22. Who will take care of the dog when the main caregiver is unable?

23. Will a choker be used on the dog?

24. Will the dog go through Obedience Training?

25. Comments:

Home Visit Date:

Performed by:

Email:

Foster:

Foster Email:

HOME VISIT REPORT - HV001 02/07

United Animal Friends, Inc.
P.O. Box 11133
Prescott, AZ 86304

(928) 778-2924

Put " yes " in the confirmation box if this form is completed and ready to send.

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