BROOD House Visit Form

Please PRINT this form (use Print Form button at bottom) and TAKE IT WITH YOU with you when you visit the prospective adopters.

Then COMPLETE THIS FORM ONLINE within two days of performing the House Visit. Please provide as much information as you can.

PART I - APPLICANT PERSONAL INFORMATION
Date of House Visit *
Applicant First Name *
Applicant Last Name *
Co-Applicant First Name
Co-Applicant Last Name
Street Address *
City *
State *
Zip *
Home Phone
Work Phone
Cell Phone
Applicants Email
PART II - THE FAMILY
ABOUT THE FAMILY (please summarize in text box below) Please list the names (if children, ages; or relationship to adopter - roommate/parent) of everyone who was present during the house visit. Does it appear that all members of the family/household (don't forget roommate, parent, semi-live-in friend) are committed to adopting a basset hound? If no, explain. Are these people young, middle-aged or seniors? Do they have the physical ability to exercise the dog(s) particularly if there is no fenced yard?
About the Family *
EXPERIENCE WITH AND RESPONSIBILITY FOR DOGS (please summarize in text box below) If you brought your own dog to the house visit, please comment on how the applicants interacted with the dog - especially the children and other animals in the house. Are they experienced dog owners (owned dogs before) or are they novice dog owners? In your opinion, do they seem like responsible dog owners?
Experience with and Responsibility for Dogs *
PLANS FOR MANAGING THEIR DOG (please summarize in text box below) Where do they plan to keep the dog while they are away from home (while at work or out for family activities)? Crate Kitchen Run of the house Fenced yard Tied outside on a line Outside kennel Other (please describe) If gone for long hours during the weekday and they do not have a doggie door, what arrangements have they considered for letting the dog out during the day for breaks (e.g., dog walker, come home for lunch, neighbor, etc.)? If the applicants have children and if they live on a busy street, how will they prevent the children from opening the door and accidentally letting the dog out (if not into a fenced yard)?
Plans for Managing their Dog *
PART III - PHYSICAL ENVIRONMENT
Type of Home *
CONDITION OF THE HOME (please summarize in text box below) Does it look as though a basset would be welcome there? Does it seem as if the applicant might be obsessively neat or contrary-wise someone who is dangerously sloppy? If the applicants seem to be neatniks, how do they feel about slobbering, shedding, furniture-hogging hounds? From your observation, does it appear that the applicants can afford to adopt a dog?
Condition of the Home *
FENCED YARD (if applicable, please summarize in text box below) How high is the fence? What type of fence is it? Is it in good repair? Does it appear to be secure? Type of gate and latch - is it easy to escape? Do they have a dog door?
Fenced Yard
OUTDOOR KENNEL AREA OR RUN (if applicable, please summarize in text box below) Is there adequate shade? Is there adequate shelter? How many hours per day will the dog be in the kennel run? Is the floor concrete or grass, and how often will it be cleaned?
Outdoor Kennel Area or Run
PART IV - OTHER ANIMALS (if applicable, please summarize in text box below)
If there are other animals in the home, what are they (dogs, cats, birds, reptiles, rabbits, etc.)? Please comment (as appropriate) on their apparent condition and happiness as you observed them (i.e., are they clean, groomed, nails at an appropriate length, etc.). How do the applicants appear to interact with these pets? If there are other animals listed as living in the home on the application, but which are not visible - were you able to meet them? Does the number of animals that are actually in the home match up with what was put on the application? If there are dogs in an outside kennel, are they listed on the application?
Other Animals
PART V - ADOPTER PREFERENCES (please summarize in text box below)
What among these are the most important characteristics that their new basset should have: Completely and reliably housetrained Gets along well with children Plays well with other dogs Doesn't bother or chase cats Is not a barker Is not shy Is able to stay alone most of the day Looks like a "classic" basset Would the applicants consider a: Basset mix Dog with health issues (if so, what?) Dog with behavioral issues (if so, what?) Senior dog (if so, what age?)
Adopter Preferences *
PART VI - WRAPUP
In your opinion, what are the applicants' strongest and weakest qualifications to adopt from BROOD? Please include both favorable impressions and anything that may have set off a "warning bell."
Applicant Strengths and Weaknesses *
Overall, how would you describe the applicants *	Highly Qualified Qualified but with Some Reservations Not Recommended to be Adopters
If anything other than Highly Qualified, please Explain
Finally, please be sure to do the following before you leave the house visit: Give them the Child Waiver Form (if applicable) Give them the Disclosure Form Discuss the Contract Ask them if they have any questions
Your Name *
Your Phone Number *
Your E-mail *

Verification Code:
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* Required Responses