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HOME STUDY FORM
Please keep these points in mind as you decide if a placement is appropriate.
1. Pet's name:
2. Date of Visit:
3. Time of Visit:
4. Name of Potential Adopter:
5. Address:
6. Telephone No:
7. E-mail Address:
8. Does the potential adopter own the home? ___Yes ___No
9. If No, is there written permission from a landlord for a pet?___Yes___No
10. Describe the neighborhood: ___Residential ___Rural ___Inner City ___Suburban
11. Describe the street: ___Average ___Busy ___Quiet
12. Is the house situated at the (front) (back) (middle) of property?
13. Approximate distance from street:
14. Is the house located near a dangerous/busy intersection or main road?
15. Is there a yard?
16. Is the yard fenced? ___Fully ___Partially ___No
17. If partially, please indicate: ___Side ___Back ___Other (describe):
18. Is there direct access from the house to the fenced area?
19. Describe the fence (height, type, and condition):
20. Is there a pool? ___Above-ground ___In-ground ___No
21. Is the pool fenced separately?
22. Are there any dogs or other animals that live adjacent to this property? If yes, are they contained?
23. Are there any dog-walking parks in the area?
24. Did you get the impression that the potential adopter understands the requirement for the dog to be leash walked and supervised when outdoors?
25. Did you meet all family members? Did you get the impression that anyone in the family is opposed to the adoption?
26. 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)?
27. Describe overall condition of the home (neat, messy, well kept, etc.):
28. Where would the dog be kept when the potential adopter is not home?
29. Is their adequate lighting/ventilation for the dog?
30. Where would the dog sleep?
31. Is there a crate available? ___Yes ___No
32. If Yes, is it of adequate size? ___Yes ___No
33. Did you meet the potential adopters' existing pets? If yes, did they appear healthy and happy?
34. Were there dog toys in evidence?
35. Describe the behavior of adults among themselves, and to any other pets or children (e.g., respectful, hectic, loud, quiet, commanding, etc.):
36. Describe the behavior of children in relation to adults, to other children and to any pets:
37. Are there any special needs, unusual circumstances or concerns that should be considered regarding the home setting? If yes, please explain:
38. Would you consider placingyour petin this home?
39. If not, politely explain that the pet would not be successful in that setting and keep searching for the right home! |
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