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

Applicants' First & Surames

Applicant Address

Applicant Phone Number

Applicant Mobile

Ages of applicants

Applicant Email

Are the applicants home owners?

Yes

No - Rented

If the home is rented, has the Applicant(s) provided proof that the landlord has given permission to have dogs?

Occupations of the applicants and hours worked

Number of other adults living in the home?

+ -

Occupations and hours of those adults living in the household and any other relevant information

Ages of other adults

Number of children living in the household?

+ -

Ages of children

n/a

0-2

3-5

6-7

8-10

11-13

14-16

Do other children visit regularly?

Yes

No

How frequently do they visit?

Ages of visiting children

n/a

0-2

3-5

6-7

8-10

11-13

14-16

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

Has the applicant had dogs before?

Has the applicant had Chinese Cresteds before?

Why have they chosen the Chinese Crested breed?

Number of other dogs in the household

+ -

Ages of all other dogs?

Breeds including cross breeds if known ?

Sex-Dog or Bitch?

N/A

Bitch

Dog

Both

Have the resident dog(s) been castrated/spayed?

Yes

No

Some

N/A

If not provide reasons for this.

Where were the resident dogs purchased from?

N/A

Rescue

Friend

Breeder

Internet

Other

If other, please provide details

Are there any cats in the household?

+ -

Are there any other pets? If yes, provide details

Do resident pets look in good health/condition? If no, provide details

How long will dog be left alone each day?

Where will the dog be kept when you go out?

Where will the dog sleep?

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?

Where would the dog be walked and how often?

Are any members of your household allergic to dogs? Provide details

Has anyone in the household ever rehomed an animal or put it into rescue? If yes, provide details

Type of property? Bungalow/ terraced house/ flat or other - Please specify

Location of Home Rural /Town/ Cul-de-sac or other - Please specify

Is the garden shared or have shared access? If yes, provide details

How high is the perimeter garden fence/wall including gates?

What is the lowest height of the garden fence/wall/gates?

Describe Dog Wanted

Dog or Bitch

Dog

Bitch

Don't Mind

Hairless or Powderpuff

Hairless

Powderpuff

Don't Mind

Age Range

Would the Applicant consider a dog with a behavioural issue? [reassure the Applicant that it is fine if they are not confident with dealing with a dog with issues] Previous experience? Exclusions of any issues, for example aggression, separation anxiety

Is there a dog the Applicant is particularly interested in? If yes, please state

Does the Applicant have use of transport?

Yes - my own vehicle

Yes - Partner/family/friends take me places

No

Would they be prepared to travel to collect a dog?

Yes - in my own vehicle

Yes - Partner/family/friend will assist

No

Is the Applicant aware that there is a minimum recommendation of £250 for the adoption of a dog, and that an adoption agreement must be signed upon adotion?

Yes

No

Unsure - will need to clarify with the Rescue

Your Opinion and Conclusions

Did you meet all of the family? This is a requirement of the home check

Yes

No

Unsure

Would you leave your own dog here?

Is this home suitable for a Chinese Crested?

Yes

No

Unsure

If no why not?

Which dog do you think would fit in well? Eg Hairless/Powder Puff - Powder Puff are fully coated Male/Female Young/Old/ Disabled/Behaviour issues

Any further comments?

Were the required photographs taken by you, the home checker? *Front and Back Gardens *Gates and Fences of rear gardens · *Entrances to the Front and Back of House · *Any potential areas of concern, for example hazards, areas the dog maybe able to escape, or areas that may need to be addressed

Yes

No

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

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

Applicants' Details