Home Check

Coordinator *

Date home check completed: * +

Applicant Information

Applicant's Name: *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number: *

Email Address

Household

Is household: *

Chaotic, people in and out constantly

Normal, people come to visit but not constantly

Quiet, few visitors

Children? *

No	Yes
No, but visit frequently	No, but visit ocassionally

If yes, how are they treated? How are they behaved?

Ages and sex of each child?

Current dogs living in house? *

No

Yes

If Yes, please list breed, sex and age of each:

How well trained are their current dogs?

Dogs next door? *

No

Yes

Unknown

If Yes, how are they treated?

Do dogs in the neighborhood run loose? *

No

Yes

Unknown

If Yes, what condition are they in?

Do other dogs visit house? *

No

Yes, infrequently

Yes, often

Does family walk dog in neighborhood? *

No

Yes, infrequently

Yes, often

Does family want to take dog to dog park or to friend's house to socialize with other dogs? *

No

Yes, infrequently

Yes, often

Cats in house? *

No	Yes, indoor only
Yes, outdoor only	Yes, indoor and outdoor

If yes, how many?

Other animals in house? *

No

Yes

If Yes, please list type and number:

How are the current animals in the house treated?

Location

Where is house located? *

City/Town

Country

Suburbs

Is property close to main highway or intersection? *

No

Yes

Within 500 feet or attached to neighbor? *

No

Yes

Acreage? *

No

Yes

If Yes, how much?

Fenced yard? *

No

Yes

If yes, what type of fence (partially see through, stockade, chain link, etc)?

Will the Dane ever be chained? *

No

Yes

Where will the Dane live for the most part? *

Inside

Outside

If outside, is there a warm, dry, and safe place out of the house?

No

Yes

Dog Runs/Kennels *

No

Yes

Swimming pool? *

No

Yes

If Yes, is pool fenced off in some way?

No

Yes

Responsibility for Dane

Is there an adult who will take responsibility for Dane's welfare? *

No

Yes

Does it appear the welfare of the dane will be left to an irresponsible child or adult? *

No

Yes

Do they understand never to leave a dog in unlocked car? *

No

Yes

Do they understand never to leave a dog in the car in summer? *

No

Yes

Will they supervise the Dane at all times when it is outside? *

No

Yes

Will they keep the Dane's vaccination and heartworm medications current? *

No

Yes

If not, what is their reasoning and how do they plan to prevent diseases?

Will a specific person(s) pick up feces? *

No

Yes

Do they understand about worms? *

No

Yes

Kind of People

Do the children present have good conduct, respect for others?

No

Yes

Does anyone in the family object to having a Dane? *

No

Yes

Do they seem like "animal people"? Do they understand animals and have warmth? *

Will they set and maintain appropriate behavioral limits (i.e. constant discipline, routine, etc. - check children's behavior for indication)? *

No

Yes

Do they know anything about obedience? *

No

Yes

Is what they know about obedience on the abusive side?

No

Yes

Why do they want this particular breed of animal at this time? *

Is someone at home during the day? *

No

Yes

Is dog left alone for over 6 hours a day? *

No

Yes

Who will take care of Dane when family is on vacation? *

Do they understand that the adoption is a transition for the Dane and that the Dane will need time to adjust? *

No

Yes

Are the adults in the household? *

Dog savvy

Well meaning but clueless

Able to handle easy issues but not behavioral

Knowledge of Breed

Do they understand specific problems of breed (Lifespan, size relative to a car, furniture, etc.)? *

No

Yes

Have they ever had a Dane before? *

No

Yes

If Yes, what happened to the Dane?

Do they understand proper and improper diet? *

No

Yes

Do they understand things harmful to this breed (bones, electric cords, detergents, waste baskets, toilet bowls, kids toys, fertilizer, etc.)? *

No

Yes

Did you discuss elevated feeding as an option? *

No

Yes

Did you discuss bloat with them? *

No

Yes

Do they understand the amount of money it will take to feed the Dane? *

No

Yes

Can they afford it? *

No

Yes

Will they pay for it? *

No

Yes

Do they understand the amount of money it will take to pay the veterinarian if the Dane becomes ill or just for check-ups? *

No

Yes

Can they afford it? *

No

Yes

Will they pay for it? *

No

Yes

Specific Requests

Will they tattoo or microchip the Dane? *

No

Yes

Will they spay/neuter? *

No

Yes

Dane should be done prior to adoption

If they won't agree to spay/neuter, what do you think they are doing?

Do they understand what to do if an animal is missing? *

No

Yes

Will they get ID tags for the Dane as soon as possible? *

No

Yes

Will they give the name, address, and phone number of the veterinarian they will use? *

No

Yes

Already have for vet check

What is the name and phone number of the vet reference?

Will they contact us first if things do not work out? *

No

Yes

Will they contact us if they are moving and can't take the Dane? *

No

Yes

Are all their indoor stairs carpeted? *

No

Yes

No indoor stairs

If not, how will they ensure that the animal will not slip and fall down the stairs?

Other Information

Please explain any answers you feel need more information. Also, provide any additional information gained during the home check.

What type of dog do you feel would work best in this home? *

Name of person performing homecheck *

Recommendation * 🛈

Deny

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