HART-Harrisburg Animal Rescue Team Adoption Application

Adoption Application
Notify your veterinarian and personal references that HART will be contacting them about your application. You will need to give your veterinarian's office(s) permission to release information about your pets records to a HART representative.

Every cat will be spayed/neutered, up to date on shots, micro-chipped, tested for FIV/FeLV for which the results will be listed and will have been treated for parasites prior to adoption, unless otherwise specified.

Cat Adoption fees are as follows and are based on age*:

Up to one(1) year old- $135

Between one(1) to five(5) years old- $110

Older than five(5) years old- $75

If adopting two or more cats simultaneously, there is a discount of $25.

Please allow 5-7 business days for our volunteers to process your application.

*Applicaiton fees listed on the PetFinder bio of any cat will supersede this fee schedule.
HART-Harrisburg Animal Rescue Team

P.O. Box 60861, Harrisburg, PA 17106-0861 | Applications.HART@gmail.com
1. Please indicate the name of the cat(s) you are interested in adopting. *
If you don't have a specific cat in mind, briefly describe what you are looking for in a cat.
2. In the case that your first choice is no longer available, name a second choice. *
You can type things like: same personality, or same appearance, or tell us what is most important to you in a cat, and we will work to find you a match!
3. Applicant's Full Name:*

First NameLast Name
Applicant's Birthday:*

MonthDayYear
Date
4. Primary Phone:*

Area CodePhone Number
5. Secondary Phone:

Area CodePhone Number
6. Email Address:*
example@example.com
7. What’s the best way to contact you?*

Call Cell NumberCall Home NumberTextEmailAny of the above
8. List your current Employer.*
9. How long have you worked at this job? IF YOU ARE RETIRED, type the number of years you worked at your last job. *
If you are retired, your answer must be an amount of TIME. Please do not only put "retired".
10. Occupation:*
If you have not worked at your current job for more than a year, please list your previous job and employer.
11. Address of Current Residence:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
12. How long have you lived at this address?*
If you have not lived at your current residence for longer than ONE YEAR, please provide the previous address and the reason you moved.
13.Do YOU currently OWN the home where you reside, or are you RENTING or LIVING WITH someone else? If none of these apply, choose "other" and explain in the box provided.*

I own my home.I am renting my home.I am living with someone else.Other
*IF YOU ARE LIVING WITH SOMEONE ELSE: You must type the homeowner or the leaseholder's name and their relation to you in #14, and the homeowner or the leaseholder's phone number in the box on question #15. Failure to provide this information could result in an automatic denial.

IF YOU RENT YOUR HOME: Please give your Landlord or Property Management company's information below. If you own, type 'N/A'.
14. Landlord/Management Co./Leaseholder/Homeowner's Name and relation to you:**
*If Management Co., include the name of your Point of Contact within the company
15. Phone Number:*

Area CodePhone Number (Include Extentions)
16. Other People Living at Your Residence
Please list the following for each person who is living in your residence: 1.) first and last name, 2.) their relation to you, and 3.) phone number. If any of the listed people are children, list their age as well. If you live alone, type 'n/a'. *
17a. Are you or anyone living with you subject to eviction from our current residence or in the process of being evicted right now?*
17b. Have you or anyone living in your home ever been evicted from a previous residence?*
18. List NAMES, SPECIES, and AGES of CURRENT and PREVIOUS(including deceased) pets you've had in the last 5 years. If you have DOG(s), list BREED, WEIGHT and how they behave with other animals. *
19. Will you keep your adopted cat(s) indoors or outdoors?*

Strictly IndoorsOutdoors/BarnIndoor/Outdoor
REFERENCES

Please list the names, addresses, phone numbers and your relationship of two(2) personal references who have knowledge of you and your pets.

*Please try not to use family for these refrences, if possible.
20. Reference #1:*

First NameLast Name
21. Best phone number to reach them:*

Area CodePhone Number
22. What is their relationship to you?*
23. Reference #2:*

First NameLast Name
24. Best phone number to reach them:*

Area CodePhone Number
25. What is their relationship to you?*
Veterinarian Reference and Records Release

In order to process your applicaiton in a timely manner, please inform your veterinarian that HART will be calling. You must give them permission to release information about your pets records. HART requires your current pets to be up to date on their shots in order to adopt a new cat. If you have used a vaccination clinics for your pets shots, you can email a clear photo of the current records to applications.HART@gmail.com.
26. List the name, address and phone number of the Veterinarian that has seen your current and past pets. If you do not have a vet, you will need one if you adopt. Where do you plan on taking your new pet? *
27. Have you ever given up or surrendered any pet to an animal welfare organization? If yes, please explain. You MUST also include the name of the Rescue, Shelter or person who you surrendered the pet to and the city and state in which the place or person is located. If you know the name or phone number of the individual who you were in contact with about this, it would be very helpful to have that, as well. *
28. Where did you hear about this cat or about our Rescue? (check all that apply)*

PetFinderFacebookInternet search/GoogleA friend/coworkerYou are a repeat adopterSomeone from HARTBenny's Pet DepotPet Supplies PlusA HART EventAnother Rescue/ShelterYour Vet
If your answer was not listed above, please type how you heard about HART?
29. Do you have any comments or questions for us?
Enter any codes here.
I am at least 18 years of age. I agree to be contacted by HART in relation to this application. I understand that HART reserves the right to reject any applicant with or without providing a reason for rejection. I acknowledge that submitting my application does not insure approval or the securing of the cat listed.*

YES, everything in this statement is true.
30.I acknowledge that knowingly providing false information may result in the nullification of the application, and therefore would provide Harrisburg Animal Rescue Team the grounds to reject any of my future attempts to apply to adopt from them. Type your initials here*
32. Please type your name in this box to act as your electronic signature. By typing your name, you are stating that the information you have entered is truthful and binding.*
Type your name here.
The official registration of HART-Harrisburg Animal Rescue Team may be obtained from the Pennsylvainia Department of State by calling toll free, within Pennsylvainia, 1-800-732-0999. Registration does not imply endorsement.
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