Homechecker(Your) Information Name * Email * Phone Number * Interviewer Information (Person who asked for homecheck) Name Potential Adopter's Information Name Address City State - - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming House Does it appear that the current dog(s) are allowed in the house regularly? Yes No N/A Fence & Yard How big an area is fenced? Describe fencing material: Is there anything stacked near the fence that the dog could climb on to get out? Yes No Are there any potential escape routes? (Low places in the fence, evidence of digging at the fence line, holes in the fencing, loose latches, too-high gates) Yes No If so, please point them out. When you pointed out possible escape routes to the potential adopter, how did they react? Do you think they will fix the problems? Yes No N/A Neighborhood/Community Is the fence shared with neighbors? Yes No Are there other dogs or livestock on neighboring property? Yes No Can any of them get into the potential adopter's yard? Yes No Describe surrounding area (rural, suburban, urban) What potential hazards are there in the neighborhood or community? Living Arrangements Where will the dog spend the night? Where will the dog spend the day? (Check the day area for dog houses, beds or crates. Also check for water and shade.) Dog Hazards Inside Is there evidence of small children (toys, food scraps)? Remind adopters that dogs WILL destroy them if not put away. Yes No Are there sewing kits, bobby pins, wash cloths, sponges, small trash cans, razor blades, etc at dog level? If so, please point them out. Yes No Can the dog get into the trash cans? If so, please point this out. Yes No How did the potential adopter respond when you pointed out these possible dog hazards? Interaction with Current Pets How does the potential adopter(s) interact with their current pet(s)? (If no pets and you brought one of your dogs, please note that here and answer based on their interaction with your dog) Are current pets well socialized? Yes No Are they reasonably clean? Yes No Are they hand-shy in any way? Yes No After you have spent some time with them, do they relax and accept your presence? Yes No If not, how does the owner handle it? (Are they heavy handed or accepting? Do they force the issue or accept the disobedience?) Conclusions These are the subjective clinchers and we rely on our homecheckers for absolute candor. Do you feel the potential adopter will love and care for the dog properly? Yes No Do you feel the potential adopter will provide a permanent home for the dog? Yes No If this were your dog, would you proceed with the adoption? Yes No Since we have yet to regret turning down an adopter, does this adoption "feel" right? Yes No Additional Comments (Your personal feelings and/or opinions on this visit are VERY important to us!)