You are free to print this sample form for your own personal use. Use this form as a guide. Please add any questions or stipulations that are necessary.

It is important to make you aware that there are unscrupulous people who operate in rings to collect cats, dogs and other animals for abusive situations. The danger is that these people appear to be animal lovers and could easily fool you. They sometimes bring children to portray a "perfect family" image. Therefore, it is important to check all references, including a veterinarian reference, and do a home check BEFORE releasing an animal into a stranger's care. Follow-up checks are also necessary.

What Could Happen To An Animal From A "Free To Good Home" Ad?

- Tortured or killed by animal abusers
- Sold to research labs for experiments
- Used as bait for fighting dogs
- Victims of neglect
- Used as free food for snakes or other animals

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Home Check Evaluation Form


This is an example of a form which could be used when doing a home check. While doing a home check, get as much information as possible and do not be afraid to ask questions. For safety reasons, always bring another person with you. A home check should be performed after an initial adoption application has been approved.


Applicant's Name:

      Phone:
      Email:
      Address:

Type of Dwelling: (Circle One)    

Size of Home:
[estimate square footage if possible]


Setting [circle all that apply]:


Condition of Home [circle all that apply]:


Describe the home interior:
[Include type of furnishings, flooring, and general appearance. For example, "antiques with museum atmosphere", "shabby furniture", "brand new furniture and/or carpet", "hardwood/ vinyl flooring with some carpet/rugs", etc.]


Accommodations:
[Describe what accommodations the home has for a new companion animal and where this animal will be left when the guardians are not at home. For example, "access to entire home", "crate in kitchen/laundry room", "baby gate across kitchen", "basement", "garage", "outdoor run", etc.


Children:
[Give ages of children, if any, and pay special attention to the behavior of the children, the parents' responses and method of discipline, and the children's interactions with other companion animals. Note whether parents always supervise young children with other animals and if the parents seem to expect the child/children to be "responsible" for the care of the other animals.]


Family Environment:
[Describe the behavior of the adults among themselves, and to any other companion animals or children. Are they respectful, patient, hectic, noisy, loud, quiet, commanding, etc.?]


Lifestyle Compromises:
[Has the applicant thought through life-style compromises that will be required when a new animal is adopted? Give details.]


Other Companion Animals:
[Describe number, type, age, and gender of the other companion animals and give complete description of their apparent health and well being. Things to note would be skin or flea problems, condition of nails, overweight or underweight, type of collar, i.d tags, etc.]


Applicant Interaction With Other Companion Animals:

Important What was their reply?



Additional Information:

Cats:
For cats, please look into things such as:

Dogs:
For dogs, please look into things such as:

Conclusion:



   Please describe:


Additional comments:



Home Evaluator's Signature:
Date:
Contact information:


Additional Suggestions To The Home Evaluator:
Permission to reprint on this web site was granted by Myra Soden.This form was originally developed June, 1997 by Myra Soden, Appalachian Mountain Border Collie Rescue Cooperative [Virginia], c/o Knollviewe, 1091 freshwater Cove Lane, Lovingston, VA 2294, email: Knollviewe@juno.com.

This form may be copied and/or adapted for use by other rescue groups after obtaining permission from the author.


http://www.theanimalspirit.com/homecheck.html