BWR - Home Visit Report
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Date of Home Visit *
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Contact Phone Number
Applicant Name
Applicant Address
Describe The Street
Describe The Setting
Type of Home
Are any gates locked?
Is there a yard?
Clear selection
Describe fence, if any
Is there a pool?
Will the dog have access to the pool?
Will the dog have access to the garage?
Will the dog have to walk up steps, please describe
Are there any other pets in the house?
Are there any animals adjacent to the property?
Describe condition of the home
Describe condition of garage
What will the dog have as bedding?
Where will the dog sleep?
Is there a crate available?
Describe where the dog will stay when alone
Describe behavior of adults to children, other adults and other pets
Describe behavior of children to adults and other pets
Would you feel comfortable leaving your dog with this applicant?
Additional comments
Volunteer completing home check *
Date of home check *
MM
/
DD
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YYYY
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