Home Visit Form

Date of Visit:

Applicant's Name:

Home Visit Inspector's Name:

They live in a:

House
Apartment
House Condo
Trailer

Description of the Street:

Busy
Quiet
Inbetween

Description of Setting:

Rural
Suburban
Urban

Is applicant allowed to keep a pug where they live?

Yes
No

Does the applicant have a pool?

Above Ground
In-ground
No pool

If the pool is in-ground, is it surrounded by a secure fence with no way for a pug to enter?

Yes
No

If the pool is not fenced in, is there an alarm system in place?

Yes
No

Air Conditioned?

Central
Window
No

Are there stairs in the house?

Yes
Yes, Open-backed
No

Where will pug stay when left alone?

Crate
Gated Area
Bedroom
Free Reign

Where will pug sleep?

Crate
Gated Area
Bedroom
Free Reign

Will pug have free run of the house when they are home?

Yes
No

How many people live in the house?

Is there a yard?

Yes
No

If there's a yard, is it fenced?

Yes
Yes, partially
No

If there isn't a yard, is there an appropriate place for a tie out?

Yes
No

If applicable, describe the fenced area, such as height/type, condition, etc:

If applicable, is there direct access from the house to the yard?

Yes
No

Where is the yard located (in relation to the house)?

Front
Side
Behind

Is there a doggy door?

Yes
No

If home is on a busy street, do they have a gate to a way to deter pug from escaping into the street?

Yes
No

Will they take the pug off leash?

Yes
No

If yes, where?

Does the number of dogs in the household match the application?

Yes
No

How did their pets react to your dog?

Describe the behaviors of the family members amongst themselves, to other pets and/or children:

Describe the behavior of the children towards the pet:

In your opinion, is the main caretaker physically able to care for the pug?

Yes
No

Are there any special needs, unusual limitations, or other concerns that should be considered?

Would you feel comfortable leaving your dog(s) here?

What makes them good dog owners?

What made them decide on a pug?

How much time would they give the pug to adjust to the new household?

An open area for comments, clarifications, and concerns:

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