Name of dog to be adopted (if known):

(FOR AEBS USE) AEBS #:

Home visit conducted by: *

Potential adopter name: *

Address: *

City/State/Zip: *

Phone:

Date of Visit: *

Date you are submitting this form: *

What type of home is it? Apartment
House
Duplex
Condo
Mobile Home
Other
*

Does the neighborhood seem to be dog-friendly? (i.e. Are there places that dogs are welcome, like parks?) Yes
No
Not Sure
*

Is the adopter apt to move soon? (Is there a "For Sale" sign in the yard?) Yes
No
*

Is the home clean? Yes
No
*

If no, describe conditions:

Does the home appear to be "dog friendly"? Yes
No
*

If no, describe conditions:

Where will the dog be kept at night? Please describe. *

What will the dog have as bedding? Please describe. *

Where will the dog be kept when nobody is home? Please describe. *

Is there a garage? Yes
No
*

If yes, will the dog have access to the garage? Yes
No

Is the garage climate-controlled? Yes
No

Is there a basement? Yes
No
*

If yes, will the dog have access to the basement? Yes
No

Do you have concerns about the dog having access to either of the above locations? Yes
No

If yes, please describe your concerns:

Is there a deck? Yes
No
*

If yes, is it safe for the dog to be in, on or around it?

How easy would it be for the dog to escape from the house (i.e. kitchen door opens into garage where garage door is always left open; doors don't close securely.)? *

Notes about the home:

Please describe fence or wall, and any gates: *

Is the yard completely and adequately fenced or walled? Yes
No
*

If no, please describe vulnerabilities:

Does the yard appear to be "dog safe"? Yes
No
*

If no, please describe:

If there is another pet in residence, is the yard cleaned of feces regularly? Yes
No

Is there adequate shade? Yes
No
*

Are there any critters in the area that might make a dog bolt through an electric fence (if present)? Yes
No
Not sure
*

Are there any dogs or other animals that live adjacent to this property? Yes
No
*

If yes, do they appear hostile?

Is there a lot of foot traffic near the yard where people have easy access to the dog? Yes
No
*

Notes about the yard:

Did you meet the entire family? Yes
No
*

If no, who was not present?

As far as you could tell, was family member opposed to the adoption? Yes
No
*

If yes, please explain:

Is the family open and friendly, and willing to talk to you? Yes
No
*

If no, please explain:

Does the family have realistic expectations from a rescue dog? Yes
No
*

If no, please explain:

Are there children living in the home? Yes
No
*

If yes, are they well behaved and polite toward adults?

Do they act appropriately around dogs?

Have they been taught not to poke, pull, and otherwise torment family pets?

Notes about the family:

Please note that we want to ensure that adopters are not violating the animal control ordinances restricting the number of animals allowed in a household. If the adopters live the city of Albuquerque, they are allowed no more than 6 pets, with no more than 4 of those being dogs. In the county of Bernalillo, outside Albuquerque, they are allowed no more than 6 pets. All pets must be sterilized. Please bring it to our attention if the adopters have more animals than allowed, or if this adoption will put them over that limit.

Are there other pets currently in residence? Yes
No
*

If yes, please list all pets you met:

How many pets do the adopters have? (Ask them this question if the pets are not all present.)

Are all the pets spayed/neutered? Yes No

If no, please detail:

Are all the pets vaccinated and microchipped? Yes No

If no, please detail:

Are they clean and well fed? Yes
No

If no, please detail:

Are they friendly? Yes
No

If no, please detail:

Are they friendly towards other dogs? Yes
No

If no, please detail:

If there are any outdoor pets, do they have proper shelter? Yes
No

If no, please detail:

Are they properly confined? Yes
No

If no, please detail:

Are there dog toys in evidence? Yes
No

If yes, what type of toys?

Is there fresh water out? Yes
No

Is food left out all day? Yes
No

Notes about current pets:

Are there any special needs, unusual circumstances, or concerns we need to consider? Yes
No
*

If yes, please explain:

Would you feel comfortable leaving one of your own pets with this family? Yes
No
*

If no, please explain:

Does this family "pass" the home inspection? Yes
No
*

Other comments (Please indicate any recommendations you made to family.): *