Barn Buddy Adoption Application
Please note: when applying to adopt, please only complete ONE application form per household.
Name of cat(s) interested in adopting (REQUIRED)
*
Applicant Information
Applicant’s Name
*
Partner’s Name
Address
*
Apartment/Unit Number
City
*
Postal Code
*
Primary Phone Number
*
Primary Phone Type
*
Home
Cell
Work
Secondary Phone Number
Secondary Phone Type
Home
Cell
Work
Partner's Phone
Email Address (if you do not have an email, please put noemail@noemail.com)
*
example@example.com
Household Information: Applicant
Complete the information for yourself below.
Are you 18+?
*
Yes
No
What are your living accommodations:
*
House
Apartment
Mobile Home
Other
Do you:
*
Rent
Own
If you rent, what is your landlord's name and phone number:
Do you live here full time?
*
Yes
No
Please describe your property, including size:
*
Please describe the structure in which the cat will be housed:
*
How far from the road/traffic is your barn located?
*
Volume of traffic:
*
Low
Medium
High
What is the speed limit on your road?
*
Is your farm a working farm or hobby farm?
*
Pet Ownership
Have you had pets before?
*
Yes
No
Do you have any pets of your own currently?
*
Yes
No
Please list any pets that you have owned.
Pet 1: Name
Pet 1: Type & Breed
Pet 1: Age & Sex
Pet 1: Spayed/ Neutered
YES
NO
Pet 1: Declawed
YES
NO
Pet 1: Indoor/ outdoor
IN
OUT
BOTH
Pet 1: Where is the pet?
Still own
Deceased
Other
Pet 1: Where did you get this pet
Pet 1: Years owned
Pet 2: Name
Pet 2: Type & Breed
Pet 2: Age & Sex
Pet 2: Spayed/ Neutered
YES
NO
Pet 2: Declawed
YES
NO
Pet 2: Indoor/ outdoor
IN
OUT
BOTH
Pet 2: Where did you get this pet
Pet 2: Years Owned
Pet 3: Name
Pet 3: Type & Breed
Pet 3: Age & Sex
Pet 3: Spayed/ Neutered
YES
NO
Pet 3: Declawed
YES
NO
Pet 3: Indoor/ outdoor
IN
OUT
BOTH
Pet 3: Where did you get this pet
Pet 3: Years Owned
Pet 4: Name
Pet 4: Type & Breed
Pet 4: Age & Sex
Pet 4: Spayed/ Neutered
YES
NO
Pet 4: Declawed
YES
NO
Pet 4: Indoor/ outdoor
IN
OUT
BOTH
Pet 4: Where did you get this pet
Pet 4: Years Owned
What happened to the pets you no longer have?
*
Animal Care Information
Why do you want a barn cat?
*
Barn cats must be securely confined for 2-4 weeks. Do you have an area of the barn that is secure to do this?
*
Yes
No
Are you prepared to allow for this much time?
*
Yes
No
Who will be responsible for your barn cat's care?
*
Who will care for your barn cats if you are away?
*
Do you plan to provide the cat with fresh water and food daily?
*
Yes
No
Do you agree to trap or contain your barn cat in a carrier and take it to the vet should it become ill or injured?
*
Yes
No
Please provide the name of your small animal vet:
*
What other types of animals will the cats share the barn with?
*
Do you currently have barn cats?
*
Yes
No
Are they spayed/neutered?
*
Yes
No
If you have a dog is he permitted to run loose?
*
Yes
No
Don't have a dog
If yes, what provisions will be made to protect the cats?
Acknowledgement
By signing below:
I certify that I am at least 18 years of age and have the knowledge and consent of all adults living in my household.
I certify that the information I provide on this application is true and complete. I authorize the investigation of all stat
eme
nts contained on this
application and understand that the Humane Society of Oakville, Milton & Halton has the right to deny my request to adopt an animal.
I understand that this application is the property of the Humane Society of Oakville, Milton & Halton .
I understand that the Humane Society of Oakville, Milton & Halton may contact my veterinarian and I authorize access to any records held
by
that office in
regards to my current and past pets.
I would like to receive electronic communications from the Humane Society of Oakville, Milton & Halton, 445 Cornwall Road, Oakville, On. 905-845-1551. shelter@omhs.ca. I understand that I can unsubscribe at any time using the SafeUnsubscribe button at the bottom of every email. I would like to receive emails to the following email address:
example@example.com
Signature
*
Date
*
/
Month
/
Day
Year
Date
FOR OFFICE USE ONLY :
Animal Name(s)
SB#/Location
Adoption Phone Meeting
Adoption Pick-Up
Drivers Licence
Completed Review
SB Check
Address verified
Continue
Continue
Should be Empty: