First Name*
Last Name*
Address
City
State/Province
Zip/Postal Code -
Email*
Home Phone
Work Phone x
Cell Phone
Alt Email
Text/Pager Email
Applicant Name(s)*
Applicant Address*
Applicant Phone *
Date of Home Visit*
Volunteer Completing Home Visit*
Home Setting Choose all that apply: Rural Urban Suburban Other
Street traffic
Home type
Does applicant own or rent home?*
Overall assessment of home? (safe/some hazards/numerous hazards/unsafe/other - please explain)*
Does applicant(s)have experience with Dobermans?*
Is there a yard?
If there is a yard, is it completely fenced? Choose all that apply: Yes No
What type of fence Choose all that apply: N/A Privacy Chain Link Invisible Other
Does applicant(s) have a realistic plan for exercise?*
What are your concerns (if any) after visiting the home? Were they resolved by the end of the home visit?*
Were any children or pets present? Describe interaction, as well as past pets (i.e. where did pet sleep, who was caretaker)*
General Information - Please provide a basic summary of the family and environment.*
How does applicant(s) plan to train and discipline dog? *
Is applicant willing to attend obedience class?*
Are there any other pets in the home? If yes, please list type/breed.*
Has applicant previously used a crate?*
Where will the animal sleep*
Where will the animal be kept when applicant not home?*
Please provide a summary and describe anything else that should be noted when considering applicant.*
Would you feel comfortable leaving your dog with applicant(s)? Please explain.*
