HCC Adoption Application
NAME OF CAT
*
Name of person in HCC that is currently fostering the cat, if known
YOUR NAME
*
First Name
Last Name
ARE YOU OVER 21 YEARS OF AGE?
*
YES
NO
PHONE
*
E-MAIL
*
example@example.com
Preferred form of contact
*
Phone Call
Text Message
E-Mail
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Address: How long have you lived at this address? If less than a year, please provide PREVIOUS ADDRESS in FULL
*
OWN YOUR HOME?
*
If renting, do you have the landlord's permission to allow pets? PROVIDE LANDLORDS NAME AND CONTACT PHONE NUMBER. LANDLORD WILL BE CONTACTED.
*
WHAT IS THE NAME & PHONE # OF YOUR VETERINARIAN?
*
WHAT IS THE NAME & PHONE NUMBER OF YOUR VETERINARIAN? Veterinarian will be contacted to check vetting records.
*
ARE THERE CHILDREN IN THE FAMILY?
*
YES
NO
IF YES, WHAT ARE THEIR AGES?
*
IF SO, WHAT ARE THEIR AGES?
HAVE YOU OWNED PETS IN THE PAST 3 YEARS?
*
YES
NO
IF YES, WHAT HAPPENED TO THEM?
*
IF SO. WHAT HAPPENED TO THEM?
WHAT ANIMALS DO YOU OWN NOW?
*
WHAT ANIMALS DO YOU OWN NOW?
*
IF YOU OWN OTHER DOGS OR CATS ARE THEY CURRENT ON EXAMS and VACCINATIONS?
*
YES
NO
ARE THEY SPAYED OR NEUTERED?
*
YES
NO
IF NO, PLEASE EXPLAIN:
*
IF NO, PLEASE EXPLAIN
WHERE WILL YOUR CAT SPEND THE DAY?
*
WILL YOU KEEP YOUR CAT INSIDE? IF NO, PLEASE EXPLAIN
*
HAVE YOU EVER PLACED A PET IN AN ANIMAL SHELTER?
*
YES
NO
IF SO, PLEASE EXPLAIN
HAVE YOU EVER BEEN CHARGED WITH ANIMAL CRUELTY OR NEGLECT?
*
YES
NO
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HCC Adoption Application
Do you plan on DECLAWING YOUR CAT/KITTEN
*
YES
NO
Undecided
I will abide by Virginia law and not declaw this cat. Declawing will result in penalties by law.
Signature
I UNDERSTAND THAT HANOVER COMMUNITY CATS WILL BE RESPONSIBLE FOR ANY AGE APPROPRIATE VETTING AND VACCINATIONS AND THAT I WILL BE RESPONSIBLE FOR ANY ADDITIONAL VETTING. (PLEASE NOTE: SOME CLINICS WILL NOT ADMINISTER A RABIES VACCINATION TO A KITTEN UNDER 12 WEEKS OF AGE. IF YOUR KITTEN'S VETTING OCCURS PRIOR TO 12 WEEKS OF AGE, THE COST AND ADMINISTRATION OF THIS VACCINE WILL BE AT YOUR COST AND YOUR RESPONSIBILITY)ADDITIONALLY, I UNDERSTAND THAT HANOVER COMMUNITY CATS RECOMMENDS A VISIT TO MY VET BE COMPLETED WITHIN 60 DAYS OF ADOPTION.
*
YES, I understand and agree
NO, I do not understand or do not agree
DO YOU AGREE THAT ANY ADDITIONAL MEDICAL CARE NEEDED FOR THE ANIMAL WILL BE AT THE OWNERS EXPENSE UNLESS AGREED TO BY HANOVER COMMUNITY CATS?
*
YES
NO
PERSONAL REFERENCE #1
*
Name/ Phone number/ Your relationship to reference
PERSONAL REFERENCE#1 -contact info-(NON- RELATIVE and NOT LIVING WITH YOU) NAME AND PHONE NUMBER
*
Name, contact info
PERSONAL REFERENCE #2
*
Name/ Phone number/ Your relationship to reference
PERSONAL REFERENCE#2-Contact information (NON- RELATIVE and NOT LIVING WITH YOU) NAME AND PHONE NUMBER
*
Name, contact info
PERSONAL REFERENCE#3- contact info (NOT LIVING WITH YOU)
*
Name, contact info
ARE YOU FINANCIALLY PREPARED TO PROVIDE THE NECESSARY CARE FOR YOUR PET: INCLUDING PROPER FOOD, VACCINATIONS, PARASITE CONTROL (FLEAS, TICKS, WORMS, ETC.) ADEQUATE SHELTER, AND VETERINARY CARE FOR YEARLY CHECK-UPS AND MEDICAL EMERGENCIES?
*
YES
NO
BY TYPING MY FULL NAME BELOW, I AFFIRM THAT ALL INFORMATION ABOVE IS TRUE AND I AGREE TO THE FOLLOWING: *I REALIZE THAT THIS IS A LIFETIME COMMITMENT AND WILL ENDEAVOR TO GIVE THIS PET A HAPPY AND HEALTHY HOME FOR LIFE *IF THERE ARE PROBLEMS WITH THIS PET(S) OR I MUST GIVE HIM/HER/THEM UP I WILL CONTACT HANOVER COMMUNITY CATS BY EMAIL OR PHONE--- HANOVERCOMMUNITYCATS804@YAHOO.COM -or- KATHY ASHWORTH (804)683-9953 PRIOR TO ANY RE-HOMING.*I WILL NOT ABUSE, INTENTIONALLY HARM, STARVE, OR NEGLECT MY PET IN ANY WAY.*I WILL NOT USE OR ALLOW MY PET TO BE USED FOR ILLEGAL PURPOSES INCLUDING FIGHTING.*I WILL PROVIDE ALL NECESSARY FOOD, WATER, EXERCISE AND MEDICAL NEEDS FOR MY PET.*I UNDERSTAND THAT HANOVER COMMUNITY CATS HAS THE RIGHT TO DENY ANY ADOPTION APPLICATION. YOU AGREE TO PAY THE $150 ADOPTION FEE TO HANOVER COMMUNITY CATS ($25 is NON-REFUNDABLE. $125 IS REFUNDABLE IF CAT IS RETURNED IN GOOD HEALTH WITHIN 10 CALENDAR DAYS)
*
TYPE FULL NAME HERE
Submit
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