Neighborhood Describe the setting: RuralSuburbanUrbanSemi-RualSemi-urbanWoodedOpen AcreageWaterfrontHighway frontageNeighborhood street frontageCity EnvironmentProperty borders park/field Addtional comments on the setting: Describe the street: Busy Quiet In-Between Cul-de-sac Home Type of Dwelling: Single family homeTownhouseCondoTrailerApartmentMulti-family homeDuplexFarm Other: Is the inside of the home clean and neat? Yes No What type of flooring is in the home? How do they feel about accidents on their floors? Is there a basement? Yes No If yes, will a dog ever be kept there? Yes No Is there a garage? Yes No If yes, will a dog ever be kept there? Yes No Is there a Yard? Yes No If yes, is the yard clean and neat? Yes No If yes, will a dog be allowed in the yard unsupervised? Yes No Is there a fence? Yes No If yes, describe type, height, condition, secure, etc. Is the home a safe (dog proof) environment? Yes No Are there any of the following: Open Stairs InsideOpen Deck Rail/StairsSlick/Uncarpeted StairsExposed Electrical CordsPoisonous/Toxic materialsPlantsHot Tub/PoolExposed Cat Litter BoxMouse Traps/BaitSmoking Inside/Full Ashtrays Other or Further Explanation: Will a dog ever be left chained outside unattended? Yes No Are there dogs or other animals visibly adjacent to this property Yes No If yes, please describe: Is there a dog door leading outside? Yes No If yes, will a dog have unlimited access to use it? Yes No Where will the dog be kept during the day when you are home and how long will they be kept here? Where will the dog sleept at night? Where will the dog be kept when home alone? If confined, describe in detail and for how long: Where and when will the dog be fed? Family Were all members of the household present for the visit? Yes No If NO, why were other members not present? Were there children or grandchildren present during the visit? Yes No If yes, what were their ages? How did they behave in general and with animals present? Does the adoption application information match up with the physical home check? Yes No Were there other pets present during the visit? Yes No If yes, what kind? Were they well mannered, groomed and taken care of? Yes No In detail, describe each pet including personality, health, over/under weight, wearing a collar/ID tag, any notable behavior such as excessive barking, hyperactivity, biting, etc. Would you entrust an animal of your own to their care? Yes No If NO, please explain: If yes, please explain: Does the family appear to be sincere, committed and tolerant of normal dog behavior? Yes No If no, please explain: Was there anything that you saw or heard that made you feel concerned or uneasy about a dog being placed in this home? Yes No If yes, please explain: PLEASE WRITE A SUMMARY OF THIS HOME VISIT: Additional comments: Any special needs, unusual circumstances or concerns that we should consider?: