Applicant's Name *

First Name

Last Name

Date of Home Visit

MM

DD

YYYY

1. Which of the following best describes the general type of neighborhood in which this applicant lives? *

Inner-city / Downtown

Rural / Country

Suburban Neighborhood

2. Which of the following best describes the street on which they live? *

Busy / High-Traffic

Moderate Traffic

Quiet

Cul-de-sac / Dead-end

3. Are there any dogs or other animals (i.e. neighbors' pets and/or livestock) that live adjacent to this property? *

Yes

No

5. Confirm the style of the applicant's home: *

Farm / Ranch

Multi Level

Condo / Townhouse

Multi-Family

Single Level

Mobile Home

Duplex

Apartment

Other

6. Confirm, if you can, whether the applicant:

Owns

Rents

Unsure

7. Is there a yard? *

Yes

No

8. Is the yard safe for an active Greyhound to play in? *

Yes

No

9. Is the yard fully fenced? *

Yes

No

10. Does the fence completely and securely enclose the yard? *

Yes

No

Not Applicable

11. Is the fence strong enough to withstand a large dog running into it? *

Yes

No

Not Applicable

14. Would you consider this home safe for a dog? *

Yes

No

16. How do family members interact? *

[select all that apply]

Calm

Respectful

Considerate

Loud

Rude

Controlling

17. The children are: *

[select all that apply]

No children

Respectful

Considerate

Supervised

Rude

Unruly

Disrespectful

Loud

Kind to existing pets

Not good with existing pets

18. What other animals are in the home? *

[select all that apply]

None

Dogs

Cats

Birds

Ferrets

Rabbits

Reptiles

Small Rodents

19. Current pets are: *

[select all that apply]

Not Applicable

Treated Well

Confident

Well Mannered

Clean

Loved

Well Groomed

Overweight

Underweight

Well Cared For

Shy / Withdrawn

Outside Only

20. Where will the new dog sleep at night?

[select all that apply]

Loose in The House

Crated

In a Room or Bed With a Family Member

Out in The Yard

Confined to a Room by Themselves

In the Basement

In a Dog Run

In the Garage

21. Is there a crate available? *

Yes

No

23. Will the dog be allowed on the furniture?

Yes

No

25. Does the applicant have appropriate transportation to take the dog to the vet should an emergency occur? *

Yes

No

26. Would you feel comfortable leaving your own dog(s) with the applicant / family? *

Yes

No

27. Are there any special needs, unusual circumstances or other concerns that we should be considering in our evaluation of this applicant?

Yes

No

Volunteer's Name *

First Name

Last Name

Volunteer's Phone Number *

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