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