First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Type of house

Where is the home?
Choose all that apply: Rural Semi-rural Suburban Wooded Open acreage Waterfront Highway frontage Street frontage

Describe the interior

Where will the dog be when the owners are not home? Will it be inside? In a crate? Outside? In a kennel?

Describe the fencing*

Describe the kennel, if there is one.

Give the ages of the children (if any), and note their behavior and interaction with parents. Will they be supervised around the dog? Do the parents expect the children to be responsible for aspects of the dog's care?

Describe the behavior of the family. Are they noisy? Is it hectic? Are they respectful of each other?

Describe the relationship of the family members to other pets, and how they interact.

What role will the dog play in the applicant's life?

Are the other pets treated like family members?

How do the other pets behave?

Why does the applicant want an additional dog?

Does applicant believe the new dog will "train" the old dog, or vice versa?

Has the applicant ever owned more than one dog at the same time?

Is the applicant prepared for the costs, commotion, other changes from a new family member?

How committed is the applicant?

What are the applicant's responses to both good and bad behaviors? Does applicant demand perfection?

Do other dogs obey happily, or are the undisciplined and out of control?

Does applicant appear to know some basic training techniques?

Explain that re-homing is stressful for the dog and that there may be accidents during the first few weeks, even if the dog is house-trained. What is the applicant's response to an accident?

Is there any additional information you'd like to include?

Is there anything in general or specific that would make you uncomfortable about placing a dog with the applicant?

Recommendation for placement

Evaluator's Name*