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Home Visit - Volunteer Use

Home visits play an important role with the adoption process. This form should be completed by assigned volunteers who are conducting home visits.

Home Visit Form

Name of Potential Adopter:

Animal potential adopter(s) interested in:

Potential Adopter's e-mail address:

Volunteer's Name:

Volunteer Street Address:

City:

State:

Zip Code:

Volunteer's Phone Number:

Volunteer's Email:

Approximate distance from street:

Is the house located near a dangerous/busy intersection or main road?

Yes

Is there a yard?

Yes

Is the yard fenced?

Yes, Fully

Yes, Partially

If partially, please indicate:

Side Yard

Front Yard

Back Yard

Other yard obstacles (describe):

Is there direct access from the house to the fenced area?

Yes

Describe the fence (height, type, and condition):

Is there a pool?

Yes, Above Ground

Yes, In Ground

Is the pool fenced separately?

Yes

N/A

Are there any dogs or other animals that live adjacent to this property?

Yes

Are there any dogs or other animals that live adjacent to this property?

Yes

If Yes, are they contained?

Yes

N/A

Are there any dog walking parks in the area?

Yes

Did you get the impression that the potential adopter understands the requirement for the dog to be leash walked and supervised when outdoors?

Yes

Did you meet all family members?

Yes

Did you get the impression that anyone in the family is opposed to the adoption?

Yes

Did you see any signs that the potential adopter would be relocating in the near future (i.e., was there a *For Sale* sign posted on the lawn)?

Yes

Describe the overall condition of the home (neat, messy, well kept, etc.):

Where would the dog be kept when the potential adopter is not home?

Is there adequate lighting/ventilation for the dog?

Yes

Where would the dog sleep?

Is there a crate available?

Yes

If Yes, is it of adequate size?

Yes

Did you meet the potential adopters' existing pets?

Yes

N/A

If Yes, did they appear healthy and happy?

Yes

N/A

Were there dog toys in evidence?

Yes

Describe the behavior of adults among themselves, and to any other pets or children (e.g., respectful, hectic, loud, quiet, commanding, etc.):

Describe the behavior of children in relation to adults, to other children and to any pets:

Are there any special needs, unusual circumstances or concerns that we should consider?

Yes

If Yes, please explain:

As a rescue person, would you consider placing a dog in this home?

Yes

If No, why not?

Comments: As a volunteer helping SCMR with this homevisit report, we need for you to give us any insight, and feelings you may have about your visit. You are our eyes and ears and we are relying on the information you provide to help us make an informed decision. Please know that this information will remain confidential and will not be shared with the applicant.

Be as candid as you like and also, please indicate if you recommended repairing the fence, etc. so that a follow-up visit can be scheduled to ensure that this was done prior to approving this applicant.

Comments:

Thank you! Your form has been submitted.

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Chattanooga, TN 37409

423-443-4082

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