Date of HV *
Date of HV
Date of App *
Date of App
enter volunteer Name(s) conducting Home Visit
Please list age, sex, spayed/neutered and temperament of dog taken on HV
(enter Last name, First name)
List all numbers in order of contact preference
What type of home
ex: subdivision, rural, closest busy street, etc
debris, hazards, feces, etc
Type, height, locks, gates, completely enclosed, condition, etc
Briefly describe interior of home. Is it clean, tidy and safe for a dog. **Include info on type of flooring surfaces
List areas of the home dog will not be allowed. If dog allowed everywhere, enter "None"
List stairs or other hazards in home dog will encounter.
BRIEFLY list experience with training, behavior issues, medical, etc
Has applicant ever relinquished a dog to shelter/rescue, etc? Explain why if yes.
Has the family adopted a rescue dog before?
Previous pets
What happened to previous pet(s)?
Are there children living in the home?
List name, gender and age of each child
How do the children react to volunteer's dog?
Will rescue golden come into regular contact with children under the age of 10 that do not live in the home?
If yes, describe how often, what ages, and relationship to applicant(s)
Daycare or babysit
Does the applicant(s) operate a daycare or baby sit in their house?
What is the family's opinion on how children and dogs should interact?
Own a dog
Does the applicant own a dog(s)?
Own a cat
Does the applicant own a cat(s)?
List name, age, species, breed (if dog), gender, neutered or spayed
If family has a cat, where is the litter box and cat food kept?
What brand of food do/did they feed their dog(s)?
Do they plan to adopt any other pets in the future (besides this one)?
Who will be primary caretaker?
How many hours will the dog be alone on a typical day?
Are they receptive to using a crate if it is necessary?
Where will the dog be kept when they are away from the house?
Where will the dog sleep?
Comments on above three questions.
How do they plan to exercise the dog? Ex: leash walk, dog park, running partner, etc
How do they plan to correct the dog's inappropriate or bad behavior? Ex: positive reinforcement, time out, scold firmly, etc
Describe the interactions between the people and their pets.
What expenses do they anticipate and are they realistic?
Age preference *
Check all that apply
Gender preference *
Activity level *
Other comments on their preferences for a golden.
Will they consider
Check all that apply
Will applicant consider a dog with special medical needs? Ex: Allergies, seizures thyroid, diabetes, arthritis, etc
Will applicant consider a dog with special behavioral needs? Ex: Separation anxiety, resources guarding, fearfulness, etc
Family members
Were all family members present and willing to participate in visit?
Suitable to adopt *
Do you think this family is suitable to adopt a GRRoW dog?
What is your gut feeling about this family and why? Are your recommendations compatible with their requests (age, energy level, etc.)
The handouts referenced in the GRRoW Home Visit Guide were discussed with the family during the visit.
Would you like to discuss this applicant with the Adoption Coordinator?