Adoption Application - Healing Animal SCARS

Date*

Date

Name of cat or kitten you wish to adopt

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Name of employer*

Name*

First NameLast Name

Relationship *

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Name*

First NameLast Name

Relationship*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Name of veterinary clinic*

Phone Number*

Please enter a valid phone number.

Do you have a different vet in mind for your new pet?*

YesNo

If you are a first time pet owner or planning on changing vets, kindly explain why:

Why do you want to adopt an animal?*

What do you think are the most important responsibilities of owning an animal?*

What kind of veterinary care do you intend to provide? When or how often do you take your pets to the vet?*

Where will your cat sleep? Are there places that your cat will not be allowed to sleep?*

Will your cat be given outdoor access? Do your current or past cats go outside?*

Please specify if you are interested in a particular animal and why:

How long has it taken you to decide to adopt a pet?*

What pets do you currently own? Please describe them in as much detail as possible (name, species, age, sex, etc.).*

Are your current pets spayed/ neutered?

YesNo

Which pets have you owned in the past? Why do you no longer own them?*

Were your past pets spayed/ neutered?*

YesNo

Have you ever had to give away a pet or surrender them to a rescue/ shelter. If yes, please explain:*

What do you consider a good and valid reason for giving up a pet? Tell us an issue that might cause you to consider rehoming your cat.*

Are you willing to take the time to work with a pet on housebreaking issues, should the need arise?*

YesNo

Do you understand and accept that changing an animal’s environment may cause the animal to have accidents, especially in the early days of the adoption?*

YesNo

How often will you scoop your cat’s litterbox? How often will you dump and replace it with new litter?*

If a behavioral problem arises, what steps will you take to work on it? What type of help would you seek if you could not solve the problem yourself?*

Would you consider de-clawing a cat, if it scratched and ruined furniture, or if the cat was aggressive and harming people?*

YesNo

Do any members of your household have any allergies to animals? If yes, please explain:*

For whom are you adopting the animal?*

SelfGift

Have you done or do you intend to do any reading in preparation for a new pet? Please specify:*

How many people reside in your household?*

Are there any children in your household?*

YesNo

If there are no children in your household currently, what will you do with your cat if you have children in the future?

Please list the names and ages of all members of your household:*

Is everyone in your household equally enthusiastic about adopting a pet? If no, please explain:*

In the absence of the primary caretaker, who will take care of your pet? How often do you travel? Where will the cat be when you travel?*

How would you describe the activity level in your home?*

Please select the type of home you reside in:*

Do you rent or own your home?*

RentOwn

If you rent, are you allowed pets? If so, which pets are allowed in your residence?

If your rent your residence, please provide the name of your landlord and their phone number:

What will you do with your cat if you move or change housing?*

What type of food will you feed your cat?*

Do your current or past cats wear a collar? Will you keep a collar with ID tags bearing your name and phone # on your cat? Or would you get the cat microchipped?*

Food*

Litter*

Treats*

Toys/beds/scratch posts*

Grooming & nail care*

Vet care (yearly)*

Are you able to comfortably provide the estimated cost of vet care, and are you prepared for other emergency costs, such as accidents or sickness?*

YesNo

How many hours per day will your cat be left alone?*

Please list any preferences you have in adopting an animal (age, sex, breed, personality, etc.):*

If your cat goes missing, what steps would you take to get it back?*

The average cat has a lifespan of 12 to 15 years, some live to be over 20 years old. Are you willing to make a commitment to this cat for the rest of his/her life?*

YesNo

If for any reason you are unable to keep your animal, do you agree to notify RESCUER immediately, and without hesitation return him/her to RESCUER if requested and work on finding an appropriate home for your cat?*

YesNo

Are you aware and do you accept that the RESCUER requires that all cats, dogs and rabbits in the household be spayed/neutered before an adoption of a rescue animal can take place?*

YesNo

Please list any other questions you may have:

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand and accept that the Rescue has the right to annul the adoption and reclaim the animal.

I give the Rescue permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by a Rescue representative before an adoption decision is made.

Furthermore, I understand and accept that the adoption decision depends upon many factors, including -- but not limited to -- the compatibility of the family and home to the individual animal and other applications received on the animal. I understand and accept that it is the Rescue’s prerogative to decide which home is most appropriate for the individual animal, and therefore I will not take issue with the decision. Unless otherwise indicated by the Rescue, I may be considered for another animal.

Date*

Date

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Name*

First NameLast Name

Signature*

Adoption Application - Healing Animal SCARS

Please provide 2 personal references who we may contact

Where do your past/present pets receive veterinary care?

Please answer the following questions as completely as possible

Please estimate the monthly cost of the following items:

Applicant Agreement