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1 Home Visit Form Fill out form below. Please complete all sections of it. Do not tell the applicant that they are approved or not approved. Let them know that you will be turning in the home visit report and they will be contacted. Home Visit Date/Time: Applicant's Address, Phone & The purpose of the home visit is to meet the prospective adopters and to see the environment that they will provide for their adopted dog. Ask yourself these essential questions: Would you be comfortable leaving your dog with this applicant?

2 Do you think that the applicant will provide a good, loving, and permanent home, will keep the dogs needs in mind, and will provide for the dog's safety at all times? Neighborhood Busy Quiet In Between Setting Rural Suburban City Homeowners Association Rules (# of pets allowed, leash law, dog runs, barking, etc)? ( if not applicable) Describe the condition of home, for example, in good repair, net, clean, etc. Are there stairways?

3 Are the pets secure in the home (open/close doors, sliding glass door left open, kids running in/out)? Do they have a fence? If so, what type & height? Is the yard totally fenced or partially fenced, it is secure & in good repair? Are there gaps in the fencing that a small hound could get through? Describe the enclosed patio or screened enclosure if any? Are there areas where a dog could injure himself?

4 Are there chemicals or trash in the yard that could harm a small hound? Will the pet have access to the garage? Is the garage in good repair, clean, no debris on the floor, hazardous substances out of reach of the pet? Are there other pets in the house? If yes, please list breed of each pet. Describe each pet's temperament and personality in as much detail as possible. Are the pet(s) obedient?

5 Are the pets overweight? Where do the pets sleep or where will their new pet sleep? Was the family receptive to your suggestions? If there are children, do the children seem like they would be respectful to the pets? Will the adults monitor the children's behavior with the dog? Are the children obedient to the parents?

6 Describe the behavior of adults among themselves and to any other pets or children, i.e., respectful, hectic, loud, quiet, commanding. How does the family interact with each other? Do they express basic considerations and caring to spouses, children, and other pets? Do the applicants have a basic understating of the pet's needs and behaviors? How will they introduce the new dog to their other pets? Are they aware of "Two Week Shutdown"? Do they understand that sometimes rescues go through a period of adjustment and that rescues are not always the most reliable in housebreaking?

7 Any special needs unusual circumstances or concerns that we should consider? If so, what? Additional tes: Your Assessment As you are meeting the applicants and their pets, you can best determine what type of rescue will fit into their home and lifestyle. Please give us your idea of what type of animal would fit best in their home. Please be as specific as possible. Would you be comfortable leaving your pet in the family's care? In other words, if you had to find a home for your own pet or needed someone to take care of them, would you feel confident leaving them in this home? Think this question over very carefully before answering!

8 Do you feel this person should be approved or not approved? Why or why not? DO T TELL THE APPLICANT THAT THEY ARE APPROVED OR T APPROVED. LET THEM KW THAT YOU WILL BE TURNING IN THE HOME VISIT REPORT AND THEY WILL BE CONTACTED. Please give an overall IN DEPTH synopsis of your home visit...your opinion matters. If at any time you get a bad feeling or don't feel comfortable with the home, please speak up. Do not be afraid to let Dawn know that you do not approve of the home. Examples of red flags that might make you refuse a home include but are not limited to: children hitting the dog or mistreating the dog, children do not listen to the parents and play too roughly with their current dog, a family member seems uninterested or not in agreement as far as getting a new dog, you see the family engaging in unsafe practices in with their current pets.

9 Any questions, please contact Dawn at (914) or HOME VISIT PERSON INFORMATION Home Visit Volunteer Signature & Date Home Visit Person - Full Name, Address, Phone & Address If nothing happens after click, please make sure that you filled all required fields. Required fields start with Is nothing happening when you click submit? Please call for assistance

Applicant: I am interested in the following animal (s): 1: Dog

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