Chesapeake Bay Retriever Relief & Rescue, Inc.
http://www.cbrrescue.org/
Home Visit Report
Name: ______Veterinary Reference: ______
Home Visit Date: ______
Address: ______
City:______State: ______Zip:______Phone: ______
Dwelling is: House Apartment Townhouse Mobile Home
Other:______
Is dwelling on an upper level? Yes No
Approximately how many stairs required for access? ______
Briefly describe applicant’s property: ______
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Is the street: Busy Suburban Urban
The fenced area should be at least 5’ tall, secure, safe, with no chance for escape. (If the fence is 4’ tall, discuss the situation.) Inspect and describe fenced area: ______
Height_____ Length_____ Width_____ Type______
How would the fenced area be used? ______
Tell us about why you are considering a (another) dog? ______
______
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What breed have you considered? ______
(discuss other breeds vs. CBRs; pros and cons of CBRs, etc.) Why do you think you might want a Chesapeake Bay Retriever versus these other breeds? ______
Previous dog experience: ______
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At what age(s) and under what circumstances did previous dog(s) die or otherwise leave your home? ______
Presently own other dogs? Yes No If yes, how many?_____
Are all the dogs altered? If not, how many: unspayed females ______unneutered males _____
Does the dog appear well cared-for? Yes No Is it well behaved? Yes No
Does it get along with other dogs? Yes No
Do you own any other animals, or do your neighbors have animals that you would like to consider in this adoption process, such as cats that may wander into the yard? Yes No If yes, please describe: ______
______
Are there regular visitors, including children or animals, to your home, with whom your new dog must get along? Yes No If yes, please describe:______
______
Is your lifestyle such that friends, relatives and children gain admittance to your home, property, and car without your supervision? Yes No If yes, please describe:______
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Work schedules of adults in the home: ______
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How many hours a day (on average) will the dog spend alone? ______
Where will the dog spend days (check all that apply)? Indoors-loose_____ Indoors-crated_____
Indoors-in a room Basement Garage Fenced yard-loose Loose-unfenced
Tied out Kennel run Other______
Where will the dog be kept during vacations? ______
How, by whom, and how often will the dog be exercised? ______
______
Who would be the primary care-giver for this Chesapeake Bay Retriever? ______
What kind of training have you completed with previous dogs (check all that apply)? None_____
Basic/pet obedience Competitive obedience Tracking Search & Rescue
Hunting Guard dog Therapy dog Agility Conformation showing
Police K9 work Other______
List all plans for this dog (check all that apply). )? None Basic/pet obedience Competitive obedience Tracking Search & Rescue Hunting Guard dog Therapy dog Agility
Conformation showing Police K9 work Other______
(Discuss that to maintain or improve a dog’s obedience level, it will take time, effort, and some money for obedience classes, etc. Look for commitment level of applicants and support form family members.)
Would you be willing to take your dog to an obedience class? Yes No
If not, why not?______
Do you have a leash law in your city/town? Yes No If yes, describe:______
______. Will applicant have equipment necessary to meet the demands of this law? Yes No
Have you ever housebroken a dog before? Yes No
Are you willing to housebreak an adopted CBR? Yes No (Discuss how it is often easy to housebreak an adult dog.)
Are you familiar with how to use a crate in a dog’s training (discuss)? Yes No
Will use one Refuses Will consider
Discuss the following – check any areas where reservations are express:
CBRs shed, ears need occasional cleaning, toenails need clipping regularly, teeth need regular brushing
CBRs (& dogs in general) should get yearly DHLPP/Bordetella booster vaccinations and they must have annual heartworm tests and take preventative for at least 9 months of the year. They also need a rabies shot every 3 years.
CBRs and other breeds can develop hip dysplasia without noticeable symptoms. The only sure way anyone can tell a dog is affected is by having x-rays read by a hip certification group like OFA. At their own expense, adopters can request that a dog be x-rayed by a vet chosen by CBRR&R and have the x-rays sent to OFA before adoption.
CBRs need daily exercise and mental stimulation to help avoid behavioral problems. (Discuss how the dog having a “job” makes for a better behaved, happier dog.)
Any preferences/stipulations by applicant in a Rescue CBR (age, color, sex), or issues that they are sensitive about?
______
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Interviewer to complete this Section at home:
Attitude of applicant(s) (overall commitment): ______
______
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Describe behavior of adults amongst themselves, and to any other pets (respectful, hectic, loud, quiet, commanding, laid back, etc.) ______
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Describe behavior of children in relation to adults, to other children, and to pets: ______
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Do applicant’s preferences/stipulations in a CBR seem realistic to you? Explain. ______
Any special needs or unusual circumstances of applicant (calm dog due to applicant’s age or disability, perhaps only a dog with some training as this will be applicant’s first dog ever, etc.)? This is your opinion and is vital information. Older people should consider knee/hip problems, etc. – What will they do on snowy days, etc.? Same with children – who will make sure to enforce that the dog is not allowed to dash out the door? Do you trust the parents to enforce this properly with the children, and do you think the children will listen? ______
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Would you feel comfortable leaving your dog with the applicant? Explain. ______
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APPROVED:
QUALIFICATIONS: ______
______
DENIED:
REASONS: ______
______
Interviewer’s Name (print): ______
Phone: ______Best time to call you to discuss this visit:______
Email address: ______
Please return completed form to:
______your Regional Director
Interviewer’s Signature
Ver: 1.A page 1 of 3
Date: 9/21/06