BTCCR Online Home visit report

Date of Home Visit::

Applicants Name::

Address::

Home Phone Number::

Cell or Work Phone number::

Type of Home::

Home::
Own
Rent

Where is the house located on the lot?:

Approximate distance home is from street::

Is there a yard?:
yes
no

Is it fenced?:
yes
no

Height of Fence::
4 Foot
5 Foot
6 Foot
7 Foot

Type of Fence:
Cedar Hedge
Chain Link
Picket Fence (wood)
PVC
Solid Wood
Wrought Iron

If partially fenced, please describe if side, backyard, etc: :

Is there direct access from house to fenced area? :
yes
no

If there is a gate, check all that apply::
Has a Lock
Lower then fence
Not BT proof, can get under or through side gap
Opens Inward
Opens Outward
Same height as fence

Is there a pool?:
yes
no

Is there a fence and/or gate around the pool area? :
yes
no

Any dogs or other animals that live adjacent to this property?:
yes
no

If yes, describe how they are contained. :

Is the house located near a dangerous/busy intersection or main road? :
yes
no

Can you see the road from the house?:
yes
no

Will the Boston Terrier be walked and supervised when outdoors?:
yes
no

How many individuals in the household?:

How many children? :

Did you meet all family members?:
yes
no

Is everyone in the family in agreement of the adoption? :
yes
no

Describe the overall condition of the home: :
Dirty
Hazardous Items
Messy
Neat
Well Kept

How many pets in the home? :

What type of pets? :

Are all pets spayed and neutered?:
yes
no

Are there toys in evidence?:
yes
no

Type of Toys::

Do they appear to be healthy and well cared for?:
yes
no

If no, describe health concerns: :

Where will the dog sleep?:

Is there a crate available? :
No
Plan on purchasing one
Yes

What will dog have as bedding?:

Describe the behavior of adults among themselves, and to any other pets or children:
Caring
Hectic
Loud
Quiet
Respectful

If the family is eatting a meal, where is the dog at? :

What type/brand of dog food are the applicants planning on feeding the dog?:

Are there dog toys and dog supplies available? :
yes
no

Plan to purchase :
yes
no

If Yes, describe: :

Describe behavior of children in relation to adults, to other children and to any pets.:

Any special needs, unusual circumstances or concerns that we should consider?:
yes
no

If Yes, please explain: :

Would you feel comfortable leaving your dog with the applicant? :
yes
no

If No, please explain: :

Other Comments: :

BT Rescue Representative of the Boston Terrier Club of Canada: Name::

Address: :

E-mail address::

Phone Number::

Dated::

Please type the text below: