To the Home Evaluator: This form is for use when doing a home visit to evaluate a potential home for a rescued Border Collie. Adoption applicants you are visiting have met preliminary criteria by having their Adoption Application accepted and by successfully completing at least one telephone interview and/or in-person meeting with a rescuer.

When doing the home visit, try to get as much information asked for on this form as possible. Ask questions and get as many details about the home environment as you find appropriate. Some of the questions on this form may not apply to a particular home. Try to bring a friend or another rescue volunteer with you on the home visit, both for the purpose of having another pair of eyes and ears to assist you in making a complete evaluation, and for personal safety.


Adoption Applicant's Name________________________ Phone___________________________


Address _____________________________________________


Type of Dwelling:


______ Single family home

______ Townhouse

______ Garden Apartment

______ Condo Community

______ High Rise Apartment

______ Row House


Size of Home (estimated square footage, if possible):


Setting (check all that apply):


________Rural _______Semi-rural ______Suburban ______Semi-urban______ Urban _____Wooded


_____Open Acreage ______Waterfront ______ Highway Frontage _______Neighborhood Street Frontage


______Country Road Frontage ______ City Environment ________ Property Bordering on Park/Field


Condition of Home (check all that apply):


_______Immaculate _______ Well-Kept ______Lived in but clean _______Exterior Untidy

______ Interior Untidy ______Exterior Unkempt/Poorly Maintained ________ Interior Trashed/Dirty


Describe home interior, including type of furnishings, flooring, and general appearance. For example, include comments such as "antiques with museum atmosphere", "shabby furniture", "brand new furniture and/or carpet", "badly stained carpet", "hardwood/vinyl flooring with some carpet/rugs", etc.

Describe accommodations the home has for a dog and where the dog will be left when owners are not at home. For example, crate in kitchen/laundry room, baby gate across kitchen door, no crate planned, pen in basement, pen in garage, outdoor run. Include complete description of any pen or kennel (chain link run, dirt run with chicken wire, etc.)


Will the dog ever be left chained or left unattended in a fenced-in yard?


Describe fencing, if any, and condition/security of fence:


Children: Give ages of children, if any, and pay special attention to the behavior of the children, the parents' responses and method of discipline, and the children's interactions with other pets. Note whether parents always supervise young children with other pets and if the parents seem to expect the child/children to "be responsible" for the care of the pets.


Other pets: Describe number, type, age and gender of other pets and give complete description of their apparent health and well being: Things to note would be skin or flea problems on other animals, overweight or underweight, type of collar/i.d. other pets have, etc.


Owner interaction with other pets: Describe the relationship all family members seem to have with other pets.


Are the other pets are treated like family members?


How do the other animals behave?


What are the owner's responses to behaviors, good and bad?


How do the animals react to the owners' response?


Do other dogs in the household obey happily?


Do owners seem to demand perfection or have unreasonable expectations regarding behavior?


Are other dogs out of control and undisciplined?


Do the owners appear to know some basic training techniques?


Please describe anything additional about the home environment that you feel is pertinent:



Is there anything in general or specifically that would cause you to feel uncomfortable about placing a dog in this home? If so, why? "Gut feelings" are considered important!




_______Approve Adoption


_______Do Not Approve Adoption


_______Adopt after additional counseling of owners and/or modifications to the home environment (describe):


Additional Suggestions to Home Evaluator: If you need to take notes during the visit, please do so discreetly on a small notepad, rather than on this form. It is preferred to have the adoption applicant(s) feel at ease with you and be themselves. Complete this form after the visit is over, when you are not in the presence of the prospective adopter(s). Qualities to note are sincerity, commitment, tolerance of normal dog behavior, honest representation of the home environment, children’s behavior with other pets and expected role of children in pet care. Obtain explanations about the absence of any family member during the home visit. DO NOT make any promises to the adoption applicants or indicate whether or not they will be approved to adopt a dog. Please refrain from discussing any particular dogs presently in rescue who may be coming available for adoption. Your opinions about which dog might be "perfect" should be discussed with AMBCR participants and not the potential adopter. Of course, you are encouraged to be complimentary and enthusiastic about a wonderful home and family, but please do not make any commitments or promises. In the case of a home you do not wish to recommend, be as polite and noncommittal as possible. Do not attempt to make corrective suggestions or impose AMBCR philosophies on applicants with home environments that do not meet our basic standards. If follow up education or counseling regarding basic dog ownership and dog care might be indicated, discuss this with the group so that a joint decision can be made about how to proceed.


Please forward this completed form to the rescuer who is considering placement of a rescue dog in this home. Your input will be welcomed and very strongly considered, but please remember that the final decision to adopt will rest with the person who is responsible for the dog. If you are considering this home environment for a dog in your care, you are encouraged to discuss the results of the home visit with other AMBCR participants.



This form developed 6/97 by Myra Soden, Appalachian Mountain Border Collie, Rescue (Virginia)

c/o Myra Soden, 3003 Happy Hollow Rd., Blacksburg, VA  24060  email: 

This form may be copied and/or adapted for use by other rescue groups after obtaining permission from the author.