HOGPC Rescue & Placement Policy - Attachment B

Placement Home Evaluation Form

(Telephone contact)

Date: ________________

Name:                                                                                                                                                

Address:                                                                                                                                 

Phone #:                                                                       Email                                                  

1.                  Why do you want a Great Pyrenees?

2.                  What do you know about the breed?

3.                  Have you ever owned a Great Pyrenees?                                                                                                                                         

4.                  If yes, what happened to it?

5.                  Do you have any other pets?         Sex?                 Spay/Neuter?

6.                  Do you have any children?             Ages?

7.                  Do you have a fenced yard?

Disposition:  Referred to available placement dog family? Y               N        

Referred to:                                                                                                                            

If no referral, state reason:                                                                                                                                                                                                                                                     

By:                                                                               HOGPC Placement Representative

HOGPC Board Approved 22-Feb-2004