CBHR Home Visit Form

Section A: General Information

Family name

Completed by

Date of visit

Type of visit:
Virtual
In person

Type of application:
Adoption
Foster

Is this a renewal of home visit?
Yes
No

Section B: House and Yard

What type of housing? House Townhouse Duplex Condo Apartment Modular Home Farm

Rent or own?
Rent
Own

Does home have central heat/air and adequate ventilation?
Yes
No

If no central heat/air, what type of cooling/heating/ventilation systems are in place?

Is yard fenced?
Yes
No

If yes:

What type of fence (chain link, privacy, picket, electric, etc.)?

Is the fenced area adequately sized for the dog?
Yes
No

Is the fence secure, free from holes, gaps, and weaknesses? If a virtual visit, have the applicant walk the perimeter of the fence and show you the entire fence. If in person, please walk the perimeter and inspect.
Yes
No

If no, please note problems:

If no fencing:

Discuss importance of leash walks and exercise?
Yes
No

Remind to never let dog have free roam outside?
Yes
No

Is there a hot tub or pool?
Yes
No

If yes, is dog adequately protected from entry into the hot tub or pool?
Yes
No

If no, please note problems:

Section C: Family and Other Pets

Is the family currently fostering, or has the family previously fostered for another rescue or shelter?
Yes
No

If so, please give name of organization and details.

Does the family have children?
Yes
No

If yes, how many, and what are the ages?

Does the entire family seem happy and committed to the idea of taking in a homeless basset?
Yes
No

Does the family have other pets?
Yes
No

If NO, skip to Section D: Plans for the New CBHR Basset Hound.

If YES, list pets here (type, breed, age). Include all pets, even types other than dogs.

Are the pets getting along?
Yes
No

Are the pets clean?
Yes
No

The dogs are on heartworm preventative. When is the next dose due?

If the applicant currently has one or more dogs, what are the dogs fed?

How often are the dogs fed?

Are food/water bowls (inside and outside) clean and of adequate size?
Yes
No

Are there toys, chews, treats, and beds provided for any current dogs?
Yes
No

Section D: Plans for the NEW CBHR Basset Hound

Where will the basset be kept during the day? Outside in fence Outside in pen Inside, free roam of house Inside, crated Inside, confined to certain room(s) Garage/basement

If outside, what provisions will be made for shelter and water?

Where will the basset sleep? Inside, free roam of house Inside, crated Inside, confined to certain room(s) Garage/basement

Comments:

If crate is to be used, is it adequately sized and in good condition?
Yes
No

Are there any questions regarding housetraining, barking, or chewing?
Yes
No

Please capture any questions regarding housetraining, barking, or chewing below:

Explain each of the following:

Applications and home visits are approved by the adoption/foster home manager or an officer of Carolina Basset Hound Rescue.
Yes
No

CBHR recommends twice daily feedings, more if the dog is malnourished.
Yes
No

Explain what heartworms are and discuss the importance of monthly heartworm preventive.
Yes
No

Importance of bathing, nail trimming, ear cleaning.
Yes
No

Telephone CBHR immediately if the fostered dog is lost or stolen.
Yes
No

Notify CBHR at least one week prior to any change of address.
Yes
No

Do not transfer the adopted/fostered dog to any other person.
Yes
No

Notify CBHR if you are no longer able to keep the dog. Once a CBHR dog, always a CBHR dog. All dogs are welcome back to the rescue, and CBHR wishes that all prospective next caretakers go through the same process as you did.
Yes
No

Please provide a final summary of the home visit: