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updated 11/09/2000

To the home evaluator: This form is for use when doing a home visit to evaluate a potential home for a rescued canine or feline. Adoption or foster applicants you are visiting have met preliminary criteria by having their Adoption or Foster Care Application accepted.
When doing a home visit please try to get as much information asked for on this form as possible. Ask questions and get as many details as possible about the home environment, as you find appropriate. Some of the questions on this form may not apply to a particular home. Some questions are species specific. Try to bring a friend or another rescue volunteer with you on the home visit, both for the purpose of having another pair of eyes and ears to assist you in making a complete evaluation, and for personal safety.

Applicant’s Name:

Phone:       Email:

Type of Dwelling:
Single family home
Town house
Multi family home

Size of home [estimated square footage if possible]:

Setting [check all that apply]:
Semi rural
Semi urban
Open acreage
Highway frontage
Neighborhood street frontage
City environment
Property bordering on park/field

Condition of home [check all that apply]:
Lived in but clean
Exterior untidy
Interior untidy
Exterior unkempt/poorly maintained
Interior trashed/dirty

Describe the home interior, including type of furnishings, flooring, and general appearance. For example, include comments such as “antiques with museum atmosphere”, “ shabby furniture”, brand new furniture and/or carpet”, badly stained carpet”, “hardwood/ vinyl flooring with some carpet/rugs”, etc.
Describe accommodations the home has for a dog and where the dog will be left when the owners are not at home. For example, crate in kitchen/laundry room, baby gate across kitchen, no crate planned, pen in basement, pen in garage, outdoor run. Include complete description of any pen or kennel [chain link run, dirt run with chicken wire, etc]

Will the dog ever be left chained out or left unattended in a fenced-in yard?

Describe the fencing, if any, and consdio/security of fence:

Children: Give ages of children, if any, and pay special attention to the behavior of the children, the parents’ responses and method of discipline, and the children’s interactions with other pets. Note whether parents always supervise young children with other pets and if the patents seem to expect the child/children to be " responsible” for the care of the pets.

Describe the behavior of the adults among themselves, and to any other pets or children- respectful, hectic, noisy, loud, quiet, commanding.

Other pets: describe number, type, age and gendered, of the other pets and give complete description of their apparent health and well being: Thing to note would be skin or flea problems on other nails, overweight or underweight, type of collar, i.d tag other pets have, etc.

Has the applicant thought through life-style compromises pet ownership will require?

Owner interaction with other pets: Describe the relationship all family members seem to have to other pets.

What role will the dog play in applicant’s life?

Are the other pets treated like family members?

How do the other animals behave?

If applicant is looking for an additional dog, or cat why does applicant what another?

Does applicant believe that the new dog will “train” old dog or vice versa?

Has applicant ever owner more than one dog or cat at the same time?

Is applicant prepared for the increased work, expense [including vet cost], and commotion?

How committed is adopter?

What are the owner’s responses to behaviors good and bad?

Do owner’s demand perfection or have unreasonable expectation regarding behaviors?

Do other dogs in the home obey happily?

Are the other dogs out of control and undisciplined?

Do the owners appear to know some basic training techniques?

How do the animals react to the owners’ response?

Explain that re-homing a dog is stressful for the dog. That the rescued dog that they want to adopt or foster may have training accidents, even if they are housebroken while they are in their present home or foster care, for the first few weeks. Ask the applicant what they would do or how they would react to the new dog having an accident. What was their reply?

Please describe any additional information about the home environment that you feel is pertinent:

Is there anything in general or specifically that would cause you to feel uncomfortable about placing a dog or cat in this home? If so, what? “ Gut feelings” are considered important.

Would you feel comfortable leaving your own dog or cat with the applicant? Explain.
This form is based mostly on the placement of a dog into the home. For cats please look into things such as litter boxes and the need to have one box per cat. Are they prepared for the extra work?

Are they prepared for the possible destructive behavior to the furniture such as clawing and scratching thing, climbing curtains, getting into plants and mischievous things cats do?

Approve Applicant
Do not approve applicant
Approve after additional counseling of applicants and/or modifications to the home environment. Please describe:

Additional comments:
Home evaluator's Signature: Date:
Contact information:

Additional suggestions to the home evaluator: if you need to take notes during the visit, please do so discreetly on a small notepad, rather than on this form. It is preferred to have the applicants feel at ease with you and to be themselves. Complete this form after the visit is over, when you are not in the presence of the applicants. Qualities to note are sincerity, commitment, tolerance of normal animal behavior, honest representation of the home environment, children’s behavior with other pets, and expected role of the children in pet care. Obtain explanations about the absence of any family members during the visit. Feel free to ask leading questions to begin productive conversation. Often good conversation will reveal far more than questions.
Do not make any promises to the applicants or indicate whether or not they will be approved to adopt or foster. Please refrain from discussing any particular animal presently in rescue that may become available for adoption.
This form was developed 6/97 by Myra Soden, Appalachian Mountain Border Collie Rescue Cooperative [Virginia], c/o Knollviewe, 1091 freshwater Cove Lane, Lovingston, VA 2294, email: This form may be copied and/or adapted for use by other rescue groups after obtaining permission from the author. This from revised 1/00 by Sarah Nicholson with permission by the author. This form revised 5/00 by Renee Ware with permission of the author.