RESCUE DOG VILLAGE
Adopter Home Visit Form
APPLICANTS INFORMATION
Applicants Name
Date of Home Visit
Address
Applicant Phone
Were all of the residents of the home present during the home visit?
Select
Yes
No
If not, please explain who was not present and why.
VOLUNTEERS INFORMATION
Name:
Phone:
Email:
EXTERIOR
Please choose, the applicant lives in a:
Select
Home
Apartment
Condo
Does the exterior of the home looked cared for?
Select
Yes
No
SETTING
Is there a garage?
Select
Yes
No
Will the dog have access?
Select
Yes
No
Please note any hazardous items in the garage if the dog has access.
Please select the setting of the home.
Select
Main Street
Quiet Neighborhood
Rural/Country Setting
Describe setting - please note traffic, other aimals nearby etc.
Is there a yard?
Select
Yes
No
Is the yard clean & free of feces, trash, debris that may be dangerous for a dog?
Select
Yes
No
Condition: Feces, trash, debris, detail any of your concerns.
FENCING
Fencing height.
Any holes or gaps?
Select
Yes
No
If yes, please note below and discuss with the applicant, explain.
Does the applicant have electric fencing?
Select
Yes
No
Is the electric fence operational? Please ask the applicant.
Select
Yes
No
Who installed their electric fence and what year was it installed?
Does the applicant have collar for the electric fence(s)?
Select
Yes
No
Please have the applicant show you that the system is operational. Enter any comments:
Who will train the new dog on the fence?
What part of the yard is fenced for a dog?
No fence - how and where will the family exercise their dog?
Is there a tie out or runner present?
Select
Yes
No
Is there evidence of a dog being kept outdoors?
Select
Yes
No
Please describe if yes:
INTERIOR
Please describe the condition and the interior of the home:
Are there lots of stairs?
Select
Yes
No
What type of flooring is present and how many floors are in the home?
Where will the dog sleep?
Where will the dog stay when left alone?
Are living areas dog-friendly?
Will the dog have free run of the house?
Select
Yes
No
Will family use a crate and how will it be used?
Will the dog be allowed on furniture?
Are there lots of small items around not intended for but interesting to a dog?
Where will the dog eat?
Is the area where the dog will eat clean?
Select
Yes
No
Are there separate eating areas for multiple dogs?
Select
Yes
No
FAMILY MEMBER - EXPECTATIONS
Who was present for the home visit?
How did the family members interact with each other, you, your dog?
What traits does the applicant expect in a rescue dog?
What behaviors does the family expect to deal with?
How long does the family expect it will take for a rescue dog to settle in?
If a dog placed with the family has adjustment issues, what will the family do?
Did you have any concerns about all members of the family, please comment:
Are there children in the home?
Select
Yes
No
What are the ages of the children?
Please describe how children interacted with your dog, note any concerns:
Does the family understand that Goldens are likely to steal small items such as toys?
Select
Yes
No
How do the applicants and children feel about this?
Do all family members understand the following?
Please read all the following statements to the applicants and note their reactions, comments and questions.
ANY dog may bite if hurt, teased, startled, awakened suddenly
All children should be SUPERVISED at all times with any dog?
Rescue dogs may take months before settling in?
Rescue dogs do not know they are home from many months sometimes and therefore are considered flight risks.
Discuss precautions needed to be made to prevent the rescue dog from escaping the safety of their new home and yard.
Discuss keeping them leashed whenever they are not in a fenced yard.
Discuss NEVER leave them outside unattended.
Discuss using extra caution that must be taken to prevent them from bolting out an open door.
Discuss rescue dogs are most likely not well-trained and we strongly suggest enrolling in professional training for bet results.
Discuss that all dogs in a new environment may have toileting accidents.
Goldens originating from the South, should be kept on heartworm for the first 12 months; then as their vet recommends thereafter.
Rescue dogs have unknown histories, no guarantees can be made about health or temperament.
Adopters MUST take their dog to their vet within SEVEN (7) days of adoption.
Do you have concerns about any family members understanding or expectations related to rescue dogs and their desire to adopt and commitment to care for a rescue dog?
CURRENT PETS
Current pet(s) name:
Current pet(s) gender :
Current pet(s) age:
How long have they owned their current pet(s):
Where is the current pet(s) kept:
Is your current dog(s);
Well behaved;
In need of training;
Well maintained;
In need of grooming;
Over weight;
Underweight;
Outgoing;
Fearful;
Shy
Agressive
Comments about the dog(s):
Are their current pets UTD on shots?
Select
Yes
No
Spayed or Neutered
Select
Yes
No
Visitor's concerns about current pets:
Were concerns shared?
Select
Yes
No
Resident dog's reaction to visitior's dog.
Does owner feel current dog is good with other dogs?
Good with males?
Good with Females?
Explain:
SUMMARY & RECOMMENDATIONS (to be completed after the home visit)
Would you leave your dog with this family?
Select
Yes
No
Do you recommend this family for a RDV dog?
Select
Yes
No
Strengths of this home:
Weaknesses of this home:
Do you have any reservations / concerns/feelings regarding this family?
Were these discussed during the visit?
Please describe age & temperament of the dog you feel would be best for this family:
Please provide any additional information you feel would be helpful in matching this family to a RDV dog.
Please describe any serious concerns you may have about placing a dog in this home.
Please list any restrictions, considerations, stipulations regarding placing a do with this family.
After you have entered all the informaiton, please click the submit button: