This page is only to be used by volunteers who have completed a homecheck

Applicant Name

Applicant Phone Number

Applicant Email

Applicant Mobile

Applicant Address

Is it rented accomodation

Yes

No

Permission letter available from Landlord?

Yes

No

Number of adults

+ -

Age

18-25

26-39

40-54

55-64

65 -79

80+

Number of Children

+ -

Age

n/a

0-2

3-5

5-10

10-13

13-18

Children Visiting?

Yes

No

Ages?

Number of dogs

+ -

Breeds inc crosses if known and their sex - Dog/Bitch

Castrated/Spayed

Yes

No

Some

N/A

Cats

+ -

Other Pets

Do you plan on moving in the next 12 months?

Yes

No

Unsure

Do you have any holidays planned in the next 12 months?

Yes

No

Unsure

Is the home rural/town/main road/ roadside?

Has anyone ever been a banned from keeping animals?

Have you ever rehomed an animal or put it into rescue? If so why?

Did you meet all the family - Please note this is a requirement of the visit

Yes

No

Unsure

Fully enclosed back garden?

Yes

No

How high is the fencing including gates?

Photographs of the garden supplied?

House or flat?

Has the applicant had Chinese Cresteds before?

Has the applicant had dogs before?

Did you discuss with applicant the following points

Costs inc vet bills

Adoption Agreement

Suggested Donation of £250

Neutering

Training

4 Weeks Petplan Insurance

Why interested in a Chinese Crested?

How long will dog be left alone each day?

What action would you take if a fight broke out between new dog and resident dog?

What facilities are available to separate dogs in the early stages of introduction? eg crate/baby gate

Describe Dog Wanted

Dog or Bitch

Dog

Bitch

Don't Mind

Hairless or Powderpuff

Hairless

Powderpuff

Don't Mind

Age Range

What if any issues is the applicant prepared to work with with new dog

Any additional comments on above

Have you seen a copy of a recent utility bill in the name of the applicant?

Your Opinion and Conclusions

Is this home suitable for a Chinese Crested?

Yes

No

Unsure

What kind of dog do you think would fit in well here?Eg HL/PP , Male/Female, Young/Old

Further Comments

If no why not?

Any further comments?

PLEASE EXPLAIN THAT THE FORMS WILL NOW GO BACK TO THE AREA COORDINATOR FOR A DECISION TO BE MADE. NO DECISION WILL BE MADE BY THE HOME CHECKER.

Date of Visit

Visited By

Email Address

I CONFIRM THAT ALL OF THE ABOVE DETAILS ARE CORRECT AND TRUE TO THE BEST OF MY KNOWLEDGE AND THAT TICKING THIS BOX CONSTITUTES AS MY ELECTRONIC SIGNATURE

Date form filled in