TLC Home Visit Form

for use by TLC Adoption Committee Members

Interested in:

Date of Visit:

Time and day of visit:

Name of Potential Adopter:


Volunteer /Foster Name:

Volunteer's Telephone No:

Volunteer/Foster e-mail address:

Describe the neighborhood: Residential / Rural / Inner City / Suburban

Describe the street: Average / Busy / Quiet

Is the house situated at (front) (back) (middle) of property?

Approximate distance from street:

Is the house located near a dangerous/busy intersection or main road?

Is there a yard?

Is the yard fenced? Fully / Partially / No

If partially, please indicate: Side / Back / Other (describe):

Is there direct access from the house to the fenced area?

Describe the fence (height, type, and condition):

Is there a pool? Above ground / In ground / No

Is the pool fenced separately?

Are there any dogs or other animals that live adjacent to this property? If yes, are they contained?

Did you get the impression that the potential adopter understands the requirement for the dog to be leash walked and supervised when outdoors?

Did you meet all family members?

Did you get the impression that anyone in the family is opposed to the adoption?

Did you see any signs that the potential adopter would be relocating in the near future (i.e., was there a *For Sale* sign posted on the lawn)?

Describe the overall condition of the home (neat, messy, well kept, etc.):

Where would the dog be kept when the potential adopter is not home?

Is their adequate lighting/ventilation for the dog?

Where would the dog sleep?

Is there a crate available?

If Yes, is it of adequate size?

Did you meet the potential adopters' existing pets? If yes, did they appear healthy and happy?

Were there dog toys in evidence?

Describe the behavior of adults among themselves, and to any other pets or children (e.g., respectful, hectic, loud, quiet, commanding, etc.):

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

Are there any special needs, unusual circumstances or concerns that we should consider? If yes, please explain:

As a rescue person, would you consider placing a dog in this home? If no, why not?

Comments (please indicate if you recommended repairing the fence, etc. so that a follow-up visit can be scheduled to ensure that this was done prior to placing the dog in this home):