Home Visit Report

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Home Visit Report

Email *

Date of Visit: *

YYYY

Length of Visit (In minutes):

Home Visit completed by: *

They are applying to: *

Adopt

Foster

Enter name of Dog they are interested in if applicable:

First Name: *

Last Name: *

Co-Applicant:

Street Address:

City:

State:

Postal Code:

Primary Phone: *

Secondary Phone:

Email (applicant):

Residence:

Residence Information:

Please describe interior and exterior, is it dog friendly, any concerns?

Rental/Apt is OK for Pet?:

Only answer if they are a renter.

Yes

Clear selection

Do they have a fenced yard?:

Yes

Clear selection

Yard Description:

Tell us about their children, including ages:(if they reside in household dog will be kept). Explain how the children interacted with the dog, were they respectful/knowledgeable, etc.

Do you they other pets?: *

Yes

Tell us about their other pets (species, breed, age). Enter none if no other pets:

If they have other dogs, please tell us the breed, gender, age, spayed/neutered for each.

Describe diet plan for their Cavalier:

Who will be their Cavalier caregiver in an emergency?:

If they are faced with an emergency, who will care for their Cavalier?

If they travel and cannot take their Cavalier, what plans will they make for its safekeeping?:

Where will their Cavalier be allowed during the day?:

Backyard

Basement

Bathroom

Bedroom

Dining Room

Family Room

Garage

Kitchen

Laundry

Living Room

Required

Where will their Cavalier be allowed to sleep?:

Backyard

Basement

Bathroom

Bedroom

Dining Room

Family Room

Garage

Kitchen

Laundry

Living Room

Required

How many hours a day on average will their Cavalier spend without a human?: *

How many hours a day maximum will their Cavalier spend without a human?: *

Cavaliers in need of training?: *

Are they willing to accept a Cavalier that has behavior problems and might require special training?

Yes

Accepting of Cavaliers with special needs?: *

Are they willing to accept a Cavalier that has been diagnosed as having a medical need that will require daily medications and frequent visits to veterinarians or specialists?

Yes

Willing to accept neglected or abused Cavaliers?:

Yes

Readiness to rescue a Cavalier rating:

New to rescue

One past rescue/Adoption

Multiple rescues

Strong rescue experience

Clear selection

Any additional notes from Home Visit Volunteer:

Today's Date: *

YYYY

Send me a copy of my responses.

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