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: