Home Visit Recheck

"*" indicates required fields

Form Notes

Notes:

Please enter answers in the spaces below. You may keep typing as long as you want, the fields will expand.
Please add as much detail as possible. We rely on your thoughts and opinions.
On questions that let you choose more than one answer, hold down the CONTROL key when clicking an answer.
Please use this form for any recheck on a former foster/adopter who has added new residents, moved to a new residence, has a new fence/yard and/or added a new dog.
IF you are doing a Home Visit because the last one was done over 5 years ago –– in that case, please use the complete Home Visit Form.
Children do not need to be present for the Recheck unless they are new to the family since the last HV.

To print a blank form click here.

Applicant Contact Information - please list all adults living in the home

Applicant's Name*

First Last

Co-Applicant's Name

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Please make sure that the phone numbers can receive text messages

Applicant's Primary Phone*

Applicant's eMail*

Co-Applicant's Primary Phone

Co-Applicant's eMail

Interview Questionnaire

General description of home: (Slick floors, steps to the front door, etc.)*

If children are present please tell us their current ages & interactions: (if not present, list N/A)*

Fenced yard?*

Any launch sites? (Wood Pile, A/C Unit, Etc.)*

Fence Information: (List Type, Height, and Condition.)*

General Description of Yard: (Include description of any stairs down to yard.)*

Fence attached to house?*

Fence secure at bottom?*

Fence Comments:*

Gate Secure? GRR strongly recommends putting locks on gates!*

Number of current dogs?*

Breed/Age/Sex/Fixed?: (if number of current dogs = "0", enter "N/A")*

Dog well cared for? (Is the dog at good weight, appears in good health?)*

Are dogs well behaved and appear to get along well?*

Plan for introduction of new dog to resident dogs: (list)*

Number of current cats?*

Age/Sex/Fixed? (if number of current cats = "0", enter "N/A")*

Number of other pets? (List types/age/sex/fixed): (if number of other pets = "none", enter "N/A")*

Please describe your training and discipline methods including the name of any trainers you've worked with?*

Special Needs or circumstances of applicant?*

Is applicant ready for a dog now, if not when?*

Do you have any travel plans and/or major commitments such as surgery, weddings, visitors, petsitting? Please be specific: list commitment(s) and dates:*

Any special requirements or requests?*

How did the applicant (and resident dogs or cats, if any) interact and get along with your dog on the home visit?*

Would you feel comfortable leaving your own dog with them?*

Home Visitor Information

Name*

First Last

Email*

Name and breed of HV dog?*

Was a copy of the email "Integrating a New Dog to your Home" webinar and 2 training resources sent to family?*

Please upload any photos or video if available.

Drop files here or

Max. file size: 1 GB.

Date Completed*

Applicant Contact Information - please list all adults living in the home

Interview Questionnaire

Home Visitor Information

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