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HOME EVALUATION FORM
To the Home Evaluator: This form can be used when doing a home visit to evaluate a potential
family for a rescued Airedale. Adoption or foster applicants you are visiting have already met
preliminary criteria by having their Adoption Application accepted and have passed the telephone
interview.
When doing a home visit, please attempt to get as much information as asked for on this form. Ask
questions, where appropriate, and get as many details as you can about the home environment.
Some of the questions on this form may not apply to a particular home so use your own judgment.
If possible, bring a friend or another rescue volunteer with you on the home visit. This helps both for
the purpose of having another pair of eyes and ears to assist you in making a complete evaluation
and for your own personal safety.Name Regina Cullen
Address 634 Stacy street
City State ZIP Raleigh, NC 27607
Phone (919) 576-5884
Email Reginacullen.cork@gmail.com
Size of Home [estimate square footage if possible]:
1800-2k sq. ftSetting [check all that apply]:
⬜Rural
⬜ Semi rural
X Suburban
X Semi urban (inside the Raleigh “beltline”, close to major metro areas
⬜ Urban
X Wooded
⬜ Open acreage
⬜ Waterfront
⬜ Highway frontage
⬜ Neighborhood street frontage
⬜City environment
⬜Property bordering on park/field
Condition of Home [check all that apply]:
Immaculate
X Well-kept
Lived in but clean
Exterior untidyInterior untidy
Exterior unkempt/poorly maintained
Interior trashed/dirty
Describe the home interior:
[Include type of furnishings, flooring, and general appearance. For example, “antiques with museum
atmosphere,” “shabby furniture,” “brand new furniture and/or carpet,” “badly stained carpet,”
“hardwood/ vinyl flooring with some carpet/rugs,” etc.]
● Older but well kept home
● Nice furniture/decor
● Hardwood floors on main level
● Basement was a mix of carpet on the “finished” side and concrete on the “unfinished” side.
Separated by a door (staircase leads down to the finished side so you can’t access the
unfinished side.
● Everything was picked up and tidy except the unfinished side – she uses this space for storage
and garage-like. Mentioned the dog would sometimes stay in that space and she would clean up
everything when the time comes.Accommodations:
[Describe what accommodations the home has for a dog and where the dog will be left when the
owners are not at home. For example, “crate in kitchen/laundry room,” “baby gate across kitchen,”
“no crate planned,” “pen in basement,” “pen in garage,” “outdoor run,” etc. Include complete
description of any pen or kennel [chain link run, dirt run with chicken wire, etc]. Will the dog ever be
left chained out or left unattended in a fenced-in yard? Describe the fencing, if any, and consider
security of fence.]
● Her accommodations with the dog when she is not home will vary depending on the particular
dog’s personality. She has had dogs that she crated when not home and others that she left
loose in certain areas of the home. She mentioned that she was flexible to make whichever
arrangements were needed depending on the dog’s needs and trustworthiness.
● When previously crating her dogs, the crate was located in the unfinished basement area.
● She has a large, well cared for backyard. It includes a creek that runs through the property and
various walking trails that she’s developed over the years. She did mention that her previous
dogs were trusted off leash to roam the yard but would only allow a new dog off-leash if she
had full confidence that it would not run off.
● Yard was mostly mulch, gardens, and brush/woods, too shady for grass.
● She had an area of the yard that had once been fenced off (she still had the old chain link metal
fencing laying around still but it was not set up). She mentioned that she would put her previous
dog in this area while she was out with it and gardening or puttering around but that the dog
didn’t love the pen so they didn’t end up using it much. She said she may consider setting it
back up if she has another dog.
● She had a wonderful large screened-in porch that looked out over both the front and back yard.
Was anticipating spending a lot of time out there with the dog too.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.]
● We did not meet any relatives and Regina lives alone but spends a significant amount of time
with her 2 grandchildren, ages 10 and 7. They have a backyard and she is over at their house 4-5
times per week. She will want a dog that absolutely gets along with her grandchildren and can
travel with her to their house and other social activities with the extended family (sporting
activities, hiking, visits, etc.)
● She is also active in her neighborhood and extended community and wants a dog that can get
along well with other dogs. She said every neighbor has a dog so they would come across other
dogs on their walks almost every time. She visits friends who have dogs (and also dog-sits their
dogs) and needs to be able to take her new Dale with her to and from their homes.
● She seemed to have full confidence in her ability to continue training and provide the right
guidelines to her new dog so that it was well mannered and behaved. Was committed to
additional dog training if need be.Family Environment:
[Describe the behavior of the adults among themselves, and to any other pets or children. Are they
respectful, hectic, noisy, loud, quiet, commanding, etc.?]Life-Style Compromises:
[Has the applicant thought through life-style compromises pet ownership will require? Give details.]
● She has an extremely active life-style of walking + socializing and plans to include the new dog
in as much of these activities as possible. Because she does not have a fenced yard, she would
take the dog on many daily walks and trips to her grandchildren’s home to utilize their backyard.
Other Pets:
[Describe number, type, age, and gender of the other pets and give complete description of their
apparent health and well-being. Things to note would be skin or flea problems, condition of nails,
overweight or underweight, type of collar, id tags other pets have, etc.]
● No other dogs in the home but she wants her new dog to get along with her best friend’s golden
retriever.
● She described her previous dogs and cats at length and they all seemed to have lived healthy
lives.
Owner Interaction With Other Pets:
o Describe the relationship all family members seem to have to other pets.o What role will the dog play in applicant’s life?
o Are the other pets treated like family members?
o How do the other animals behave?
o If applicant is looking for an additional dog, or cat why does applicant what another?
o Does applicant believe that the new dog will “train” old dog or vice versa?
o Has applicant ever owned more than one dog or cat at the same time?
o Is applicant prepared for the increased work, expense [including vet cost], and commotion?
o How committed is adopter?
o What are the owner’s responses to behaviors good and bad?
o Do owners demand perfection or have unreasonable expectation regarding behaviors?
o Do other dogs in the home obey happily?
o Are the other dogs out of control and undisciplined?
o Do the owners appear to know some basic training techniques? Yes
o How do the animals react to the owner’s response?Important Question to Answer:
o Explain that re-homing a dog is stressful for the dog.
o That often the rescued dog they want to adopt or foster may have training accidents, even if
they are housebroken, while they are in their new home or foster care, for the first few
weeks.
o We discussed the need to reinforce training with a new rescue dog and that many
rescues often come with quirks and traits they need to work through with a new family.
Regina seemed confident that she could work through what was needed or provide
additional professional training.
o Ask the applicant what they would do or how they would react to the new dog having
an accident.What was their reply?
Additional Information:
o Please describe any additional information about the home environment that you feel is
pertinent.
o Is there anything in general or specifically that would cause you to feel uncomfortable about
placing a dog or cat in this home?
o We don’t have any uncomfortable feelings about Regina – she was very fit and confident
in her abilities to control a 50-70 lb Airedale. Our only concern was that at age 75 there
is no guarantee how fit she will be in 5-10 years. She was pretty insistent that she
wanted a puppy or very young Airedale and while she is providing plenty of exercise
now, we hope that in the future (10-12 years of the dog’s lifespan) she could still
continue to do so. Without a fenced in backyard, she wouldn’t really have a fall back
plan. (Although she DID mention she could fence in her yard if she had to)
o She mentioned a few times playing with her previous dogs loose at the end of her dead
end street or in the field nearby or around in her yard. We mentioned that she had to be
very careful when playing off leash ESP with a rescue dog. That may need to be
reiterated to her.o If so, what?
o “Gut feelings” are considered important. Would you feel comfortable leaving your own dog
with the applicant?
o Explain.
oConclusion:
X Approve Applicant
Do not approve applicant
Approve after additional counseling of applicants
and/or
Approve after modifications to the home environmentPlease describe:
Additional comments:
Home Evaluator’s Signature: Melissa & Jeremiah Jordan
Date: May 20, 2024
Contact information: Email & Phone No.: 561-212-3209 / 850-245-0030
mjv213@gmail.com / jeramiahj850@gmail.comAdditional Suggestions To The Home Evaluator:
● If you need to take notes during the visit, please do so discreetly on a small note pad, rather
than on this form. It is preferred to have the applicants feel at ease with you and to be
themselves. Complete this form after the visit is over, when you are not in the presence of the
applicants.
● Qualities to note are sincerity, commitment, tolerance of normal animal behavior, honest
representation of the home environment, children’s behavior with other pets, and expected
role of the children in pet care. Obtain explanations about the absence of any family members
during the visit. Feel free to ask leading questions to begin productive conversation. Often
good conversation will reveal far more than questions.
● Do not make any promises to the applicants or indicate whether or not they will be approved
to adopt or foster. Please refrain from discussing any particular animal presently in rescue
that may become available for adoption.Christina Prange
10:27 AM (50 minutes ago)
to mjv213@gmail.com, jeramiah.fitness@gmail.com, mehi Melissa and Jeramiah, ARG needs a home visit in Raleigh and I wanted to ask if you’d be willing to help us to conduct the home visit. I always try to ask Raleigh people in the ‘area’ of the home so you’re not driving all over. This home is over by NCSU/Meredith college area. The applicant has been through an interview, vet references and they are airedale experienced. Do you all have time to help with a home visit in the upcoming days/weekends. Since it is lighter after work – if you can arrange it that a week day is better, that’s fine. If you have a free weekend – that’s fine too. Let me know – thank you!
Christina Prange
919-605-4563Hi Daniel-
We have a release form for Doby, a 9 yr old male. Living outside, escape frequently, lots of energy. Release form states:
Energetic, always on the go, Sweet and cuddly, Patient and Tolerant of kids, Able to be one of several animals in our home.
Christina is calling the owner today.
Also a 2-3 yr old male is on stray hold in Dekalb Cty GA. He is a frequent flyer for running at large. He is with a foster for the shelter. The owner has through the 16th. Typically they claim the day before available. So I am not sure we will get him. His name is Max.
Lastly we were contacted about a mix, potential mix, that needs a new home. Sparky is 1.5 yrs old. We generally do not take mixes but I could connect you with the daughter of the owner that is looking to rehome him. Sparky he now weighs about 80 pounds, He is UTP on all shots, he is neutered, He is a fun spunky good boy, just too strong for my father. He has had some day training at Astro Kennels in Mauldin, South Carolina. Located in Simpsonville, SC.
Let me know if any of the 3 interest you and your family.
owner came forward, Jason Watson. After many emails with Chirstina Prange, the owner was identified and “Biscuit” is being returned on 5/12/2024.
Returned to Owner.
5/5/24 held for 5 day SC hold, no one came forward.
Moved to adopted on 5/5. Daniel Danieley.
Renamed Bruce
Vetted in 5/3/24.
Patient ID: 21185 Sex: Neutered Male Invoice Date: 03-May 2024
Patient: Olly Group Birth Date: 03-May 2022 Invoice Number: 761901
Species: Canine Weight: 104.000 lb
Breed: Airedale
Product / Service Quantity Price (Exc) Tax Amount
Physical Exam – With Vaccines 1.00 72.50 0.00% 72.50
Canine Rabies 1 Year Booster 1.00 18.00 0.00% 18.00
DA2PP Vaccine (Canine) Three Year Booster 1.00 28.00 0.00% 28.00
Heartworm Test – Occult In House 1.00 51.00 0.00% 51.00
Fecal Exam – Centrifugation 1.00 41.50 0.00% 41.50
Home Again Microchip 1.00 77.00 0.00% 77.00
Subtotal 288.00
Tax 0.00
AMOUNT DUE 288.00
Debit Card
Ref: visa
288.00
INVOICE BALANCE 0.00Reminders for Olly
Physical Exam – With Vaccines 03-May 2025
Rabies Booster 03-May 2025
Heartworm Test 03-May 2025
Stool sample for parasite check 03-May 2025
DA2PP Vaccine (Canine) Three Year Booster 03-May 2027Microchip: 985113008924691
On Fri, Apr 26, 2024 at 1:45 PM Rebecca Wolbers
In late December we took Mac to the vet and they found a mass in his spleen. They tested and thought he was good for surgery to remove his spleen. He was 11. He had the surgery and it wasn’t cancer. He was recovering great and one morning he collapsed. We went to the urgent vet and it was too late; they think it was internal bleeding.Lilly – she was grieving over Mac of course. We took her to daycare some and she was doing good. A couple days she didn’t eat so Jay took her to the vet and they did tests and ultrasound. She had blood vessel cancer and multiple masses in her spleen. They suspected some were bursting. They said it would only be a few weeks more with her. They gave her a supplement to help with the blood and she lived right at another 3 weeks. One day she was crying most of the morning so we took her to vet and they think more masses were bursting. She was happy as could be those weeks and was acting like a puppy. She would have been 14 in July.
I think we are interested. Jay seemed to be onboard, and wanted to also know about her with other dogs.
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