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In-Home Interview Feedback
1. Adopter Name:
2. City:
3. Adopter Occupation(s):
4. Interviewer Name:
5. Interviewer Email, Phone:
6. Interview Date:
7. Family members: names and ages. Who was present?
8. If this is a rental, have you seen the landlord’s written approval?
9. Describe the size or dimensions of yard. Describe the layout:
10. Is there anything in the yard that can create a hazard for the dog?
11. Describe the fencing in any area where the dog will have access. Look for any hazards or escape routes: loose boards, nails, etc.:
12. Are there any planters, furniture, shelves, etc. a dog could use to jump the fence?
13. Are the gates padlocked? If not, what type of locking mechanisms are there?
14. Who has access to the yard? Where are the utilities? Where will the dog be when workers enter the yard?
15. Will the dog have access to the garage? Are there any hazardous materials evident in the garage?
16. Is the swimming pool or spa covered or fenced? If not, have you discussed pool safety?
17. Where will the dog be kept when the family is away during the day? Is there adequate shade, shelter and water?
18. How will the dog be cared for when the family is away on vacation or extended periods of time?
19. Describe any other pets in the home. Do they appear well cared for? Is there evidence they are allowed in the house?
20. Is the inside of the home safe for a dog? Describe any concerns. Are the stairs, if any, carpeted?
21. Where will the dog sleep at night?
22. What is the apparent activity level of the applicants? What kind of activities will they share with a dog?
23. What are the applicants looking for in a Golden: age, gender, energy level? What do you think would work best here?
24. Add any additional comments. Would you leave your dog here?
25. Amount of donation received:
25a. Donation made by:

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