Submit Home Visit Feedback
Name of volunteer conducting visit
First Name
Last Name
Date home visit completed
*
-
Month
-
Day
Year
Date
Applicant's name
*
First Name
Last Name
Was this a pet evaluation only?
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Yes
No
Applicant has attended Orientation
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Yes, already attended
No, planning to attend
Not required (Prison fosters only)
Please list all adults and children in the home and their ages.
*
Please list who will be the Primary Handler.
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Are they physically able to handle a large breed dog?
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Please Select
Yes
No
Mild concerns, requires staff follow up
Select the property type.
*
Please Select
Single-Family
Townhome
Apartment
Condo
Select the community type.
*
Please Select
Urban
Suburban
Rural
If you made suggestions for "puppy proofing" during the home tour, please list what was addressed.
If applicable, please describe the yard and fence.
Note the height and materials used for the fencing.
Let us know which dog accompanied you to the home visit.
*
How did the applicants react to the visiting dog?
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Indicate pets in the home.
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No pets
Cat(s)
Dog(s)
Small animal
Bird
Reptile
Large animal
Other
Information on applicant pets
List the age, gender and breed of all DOGS.
*
Are any dogs in the home INTACT?
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No, all dogs are spayed/neutered
Yes, at least one dog in the home is INTACT
Are resident dogs up to date on vaccinations?
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Yes
No
Unsure, requires follow up
Tell us how the resident pets reacted to the visiting dog.
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Describe the primary handler's vehicle.
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Include make and model as well as their plan for transport of the foster dog.
What dog handling or training experience do the applicants have?
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What kind of handler would they describe themselves as?
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Describe how they would handle undesirable behaviors.
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For example, counter surfing, barking on walks, potty accidents in public.
How do they plan to exercise the dog?
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Describe the anticipated daily schedule for the Can Do Canine.
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For example, home 8+ hours Tues, Th or home alone daily 4 hours, etc.
Are they able and willing to foster a dog of any age?
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Are adults able to provide necessary potty breaks for young puppies and dogs?
Will they foster a female while in heat?
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Yes
No
Maybe, need more information
What is their greatest concern, if any?
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What roles are the applicants interested in?
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Sitter
Raiser
Weekend Prison Sitter
Prison Break Raiser
What roles do you feel are the best fit for the applicant?
Sitter
Raiser
Weekend Prison Sitter
Prison Break Raiser
Would you recommend this applicant? Tell us why or why not.
*
Please be detailed and list any concerns.
Submit
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