Barn Buddy Application
Name
*
First Name
Last Name
Date
*
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Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
How did you hear about the Barn Buddy Program?
*
Household Information
What is the size & description of your property?
*
Do you rent or own your property?
*
Rent
Own
If applicable, does your lease allow pet(s)?
*
Yes
No
If you rent, please provide landlords name and contact information
Do you live at your residence full time?
*
Yes
No
If no, please explain
Describe the structure in which the cat will be housed
*
How far from the road/traffic is the structure located
*
Animal Care Information
Why do you want a barn cat?
*
How many cats would you like and why?
*
We encourage your barn cats to be individually confined in a secure enclosure for 2 weeks with food, water and clean litter distributed daily. This helps the cat accustom itself to its new surroundings, provides a safe haven, and encourages the cat to return to this area in the future. Are you prepared to arrange for this set up and length of time?
*
Yes
No
Do you have a large crate to accommodate this?
*
Yes
No
Do you have other cats on the property?
*
Yes
No
Please list the current pets you have and if they are spayed/neutered
If you have a dog, is he/she permitted to run loose?
Yes
No
If yes, what provision will you make to protect the cat?
Who will be responsible for their care?
*
Who will care for your barn cat if you are away?
*
Do you agree to trap and take a barn cat to the vet if it becomes ill or injured?
*
Yes
No
How often do you plan to feed or water the cat?
*
Please provide the name and contact information of your small animal veterinarian
*
I acknowledge that the adoption fee for a Barn Buddy cat is $25 per cat and that the cat will be sterilized, receive all necessary vaccines/treatments and that the microchip will be registered to me
*
Follow Up
May staff from HSKWSP follow up with the adoption?
*
Yes
No
I have read the above information carefully and have filled out this application honestly. I certify that the information I have given is true to the best of my knowledge. I understand that intentional omission of information and/or failure to answer all questions honestly can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that The Humane Society of Kitchener Waterloo & Stratford Perth (HSKWSP) reserves the right to annul the adoption and reclaim the cat. I give the HSKWSP Adoption team permission to fully confirm the information provided, as well as contact veterinarians and related officials.
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
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