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Fields marked with an * are required

Date of Visit: *

Length of Visit: *

In minutes

HV Completed by: *

HV completed by email: enter email if you want a copy of this emailed to you

They are applying to: *

Enter name of dog they are interested in (if applicable:

First Name: *

Last Name: *


Street Address:


Phone (home): *

Phone (Mobile):


Postal Code:

Email (applicant): 


Residence Information:

Please describe interior and exterior, is it dog friendly, any concerns?

Rental/Apt is OK for Pet?:

Only answer this question if you they are a renter.  

Do they have a fenced yard?:

Yard Description:

Tell us about their children, including ages:

(if they reside in household dog will be kept)

Explain how the children interacted with the dog, were they respectful/knowledgeable, etc. 

Do they have other pets?: *

Tell us about their other pets (species, breed, age).  Enter none if no other pets: *

If they have other dogs, please tell us the breed, gender, age, spayed/neutered for each.

Describe diet plan for their Cavalier *

Who will be their Cavalier caregiver in an emergency?: *

If they are faced with an emergency, who will care for their Cavalier?

If they travel and cannot take their Cavalier, what plans will they make for its safekeeping?:

Where will their Cavalier be allowed during the day?: *

Where will their Cavalier be allowed to sleep?: *

How many hours a day on average will their Cavalier spend without a human?: *

Accepting of Cavaliers with special needs?: *

Are they willing to accept a Cavalier that has been diagnosed as having a medical need that will require daily medications and frequent visits to veterinarians or specialists?

How many hours a day maximum will their Cavalier spend without a human?: *

Cavaliers in need of training?: *

Are they willing to accept a Cavalier that has behavior problems and might require special training?

Willing to accept neglected or abused Cavaliers?: 

Readiness to rescue a Cavalier rating:

Any additional notes from Home Visit Volunteer: 

Today's Date: *

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