Our Adoptable Pet List 

Home Visit Form

Please note the use of the Enter key will submit the form - use the mouse or Tab key to navigate the form fields to avoid accidentally submitting an incomplete form.

SCMR foster requesting this home visit:

Email address of SCMR foster requesting this home visit:

Please enter the email address again to confirm accuracy:

Animal potential adopter(s) interested in:

Name of Potential Adopter:

Address:

City:

State:

Zip:

Potential Adopter's e-mail address:

Volunteer's Name:

Volunteer's Address:

City:

State:

Zip:

Volunteer's Telephone No:

Volunteer's e-mail address:

Describe the neighborhood: - select an answer -ResidentialRuralInner citySuburban

Where is the house situated on the property? - select an answer -FrontMiddleBack

Approximate distance from street:

Is the house located near a dangerous/busy intersection or main road? Yes No

Is there a yard? Yes No

Is the yard fenced? Yes, fully Yes, partially No

If partially, please indicate:
Side yard Front yard Back yard

Other (describe):

Is there direct access from the house to the fenced area? Yes No

Describe the fence (height, type, and condition):

Is there a pool? Yes, in-ground Yes above ground No

Is the pool fenced separately? N/A Yes No

Are there any dogs or other animals that live adjacent to this property? Yes No

If Yes, are they contained? N/A Yes No

Are there any dog walking parks in the area? Yes No

Did you get the impression that the potential adopter understands the requirement for the dog to be leash walked and supervised when outdoors? Yes No

Did you meet all family members? Yes No

Did you get the impression that anyone in the family is opposed to the adoption? Yes No

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)? Yes No

Describe the overall condition of the home (neat, messy, well kept, etc.):

Where would the dog be kept when the potential adopter is not home?

Is there adequate lighting/ventilation for the dog?
Yes No

Where would the dog sleep?

Is there a crate available? Yes No

If Yes, is it of adequate size? N/A Yes No

Did you meet the potential adopters' existing pets?
N/A Yes No

If yes, did they appear healthy and happy? N/A Yes No

Were there dog toys in evidence? Yes No

Describe the behavior of adults among themselves, and to any other pets or children (e.g., respectful, hectic, loud, quiet, commanding, etc.):

Describe the behavior of children in relation to adults, to other children and to any pets:

Are there any special needs, unusual circumstances or concerns that we should consider? Yes No

If yes, please explain:

As a rescue person, would you consider placing a dog in this home? Yes No

If no, why not?

Comments: As a volunteer helping SCMR with this homevisit report, we need for you to give us any insight, and feelings you may have about your visit. You are our eyes and ears and we are relying on the information you provide to help us make an informed decision. Please know that this information will remain confidential and will not be shared with the applicant.

Be as candid as you like and also, please indicate if you recommended repairing the fence, etc. so that a follow-up visit can be scheduled to ensure that this was done prior to approving this applicant.

SCMR Appreciates Your Help!