Cbr home visit 2015

CBR – Home Visit Form

Home Visit Report

Home Visit Detailed information

Date of Home Visit:

Applicant Name:

Applicant Address:

Applicant Phone#

CBR Volunteer:

Housing/Demographics

Important Note – Comments are optional.

Demographics Details

Describe the Street Busy____ Quiet_____ In-Between _____

Comments:

Describe the Setting Rural____ Urban____ Suburban______

Comments:

Is there a Yard? Yes_____ No_____

Comments:

Is the Yard Fenced? Yes (Fully)_____ Yes(Partially)_____ No______

Comments:

If Yes, Describe the Fence (Height, Type, Condition):

Is there a lock on the gate? Yes_____ No_____

Carolina Boxer Rescue www.carolinaboxerrescue.org

PO Box 87 Hampstead, NC 28443

Phone (910) 799-5638 Fax 800-450-0563 Email [email protected] of 5

Demographics Details

Are there any dogs, cats, or other animals that live adjacent to this property?

Yes______ No_______

If Yes, list the type and how they are contained:

Describe the condition of the home (Interior/Exterior, in good repair, neat, clean, safety concerns)

Describe the Garage (in good condition, chemicals, hazards)

Garage accessibility Will the dog have access to the garage?

Yes_____ No______

Tip – The indicates this is the

answer/response box. Simply type your continuous

answers in this box, or start a new sentence or

thought at the next arrow. Pressing ENTER in this box

will cause you to leave the response box.

1. Is there a crate available?

Yes_______ No_______ Plan to Purchase_______

2. Where will the dog sleep?

http://www.carolinaboxerrescue.org/




3. What are your plans for dog bedding, if any?

4. Are there dog toys available?

Yes_______ No_______ Plan to Purchase_______

5. Where the dog will be kept when home alone? (Ex: they plan to crate him/her, or they plan on gating off a room, etc.)

6. How do you think you have prepared for your new dogs arrival?

7. Describe the environment of the home (Behavior and demeanor of the adults, children and any other pets, is the home loud, chaotic, mellow…)

8. How do the children seem to interact with the adults in the home, or any other pets that may be in the home?





9. Are there any special needs or circumstances that we should consider?

Yes_______ No_________ If Yes, Please explain:

10. Would you feel comfortable leaving your own pet with this applicant?

Yes_______ No_________ If No, Please explain:

11. If they currently have a dog(s), Ask for a description about how their dog(s) get along with other dogs (dominant, submissive, playful, Alpha, fearful)…

Additional Comments:

Type Additional Comments Here:

What’s Next? (Things to share with the Potential Adopter).

Approval: Within 3-4 days, a CBR representative will email an approval

or denial to the main email listed on the application.

Selecting a dog: After approval, the person responsible for the

geographic area (called an “Area Coordinator”) will be in touch to see

what type of boxer the family is looking for. They will also record any

specific dogs you are interested in. If available, the Area Coordinator

will put you in touch with the dog’s foster parent to talk on the phone

and potentially arrange a meeting.

Important Note – Please ask them to not get their heart set on one

specific dog. The dogs seen on Facebook and webpage now may be

meeting with adopters that were approved months ago. We are

always taking in new dogs and a potential match may be right around

the corner!

Please be patient with us, we are 100% volunteer run and do all of this

in our spare time.





Returning the Form:

1)Scan and email it to us. Please send to Kathy and Cricket at:

[email protected] and [email protected]

2) Fax it to us at 800-450-0563

3) If you cannot scan or fax it in, you can email just the summary info to Kathy

and Cricket.

CBR Representative Signature:____________________________________________

Date: _____________


mailto:[email protected]

mailto:[email protected]

Cbr home visit 2015

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