PO Box 87 Hampstead, NC 28443 Phone: 910-799-5638 Fax: 800-450-0563 www.carolinaboxerrescue.org email - carolinaboxer@gmail.com Home Visit Report Home Visit Date: Applicant Name: Address: Phone Number: 1. Location Describe the street: Describe the setting: Is there a yard:
Busy _____ Quiet _____ in-between _____ Rural _____ Suburban _____ Urban _____
Yes _____ No_____
Is the yard fenced:
Yes, fully _____ Yes, Partially _____No _____
Describe the fence (height, type, condition): Is there a lock on the gate?
Yes_____ No_____
Are there any dogs or other animals that live adjacent to this property?
Yes____ No____
If Yes list type, and describe how they are contained:
Describe the condition of the home: for example, in good repair, clean, neat. Is there a garage? Yes_____ No____ Describe the garage: for example, in good repair, clean, no debris on the floor, hazardous substances out of reach of the dog.
Will the dog have access to the garage? Yes____ No ____
2. Dog Care/feeding Where will the dog sleep? What will dog have as bedding? Is there a crate available? Yes_____ No____ If Yes, describe the dimensions, and type
List the ways they have prepared for the new dog's arrival:
Describe where dog will be kept when home alone.
Are there dog toys available? Yes____ No____ Plan to purchase_____ Where will the dog be fed? What will the dog be fed? What are your plans for caring for your dog if you are away/out of town? Will your dog wear a collar with ID tags at all times? Will your dog be taken to the vet for yearly health checkups and heartworm testing? Will your dog be kept current on vaccines and/or will you make sure that they have immunity to infectious diseases by checking titers?
3. Family dynamics Describe the behavior of adults among themselves, and to any other pets or children - respectful, hectic, loud, quiet, commanding.
Describe behavior of children in relation to adults, to other children and to any pets.
If they currently have dogs, ask them to describe how their dog gets along with other dogs (dominant, alpha, submissive, playful):
4. Financial Have you budgeted for recurring expenses (food, flea/tick/HW treatment, regular vet care toys, etc.) related to caring for a new dog in your household?
How do you plan to deal with emergency expenses that may arise related to a new dog?
5. Any special needs, unusual circumstances or concerns that we should consider?
6. Would you feel comfortable leaving your dog with the applicant? Yes_____ No_____ If No, please explain:
7. Are there any circumstances under which you would consider returning your adopted dog to rescue?
8. Comments/further information:
CBR Representative Signature ________________________________________Date________________