BHR Cat Adoption Application

Broken Hearts Rescue Cat Adoption Application
Today's Date*

MonthDayYear
Name of the cat you are interested in:*
Adoption Guidelines:
- 18 years of age or older
- If renting - a letter stating you may have a cat and any restrictions.
- Be able/willing to provide for the cat financially and emotionally to include time and medical care.
- All current animals in household must be spayed/neutered unless there are medical reasons not to.
- We do not ship furkids, a meet and greet with all people at the home and the cat is required.
- A homecheck may be required.
Please initial that you have read and understand the above guidelines:*
Completion of this application does not guarantee the adoption of a cat. Broken Hearts Rescue (BHR) reserves the right to deny any application if we feel that the cat is not a good fit for your family or environment. Please understand that we have the cat's best interest in mind and we will place the cat in the best home suited for them, not the first one that applies. This does not necessarily mean that your home is not suitable, but that there may be a better suited home for that particular cat. If our representative determines that you are not the right fit for the cat, and you would like to adopt another of our cats, you may transfer the application to another cat in our foster program by emailing us or talking with a representative. Our ultimate goal is to place each cat in the best suited environment for them. Each cat has its own personality therefore each cat will be assessed while it is in foster care to see what type of family it will best be suited for. Keep in mind that adopting a cat is a lifetime commitment and not a temporary one. Many of our cats have come from less than desirable backgrounds and deserve a good, loving home that will treat them as family, not put them outside and have no contact with them. It is hard on them to be moved from home to home. Throughout the application please mark all items that apply when there are choices.
Please initial that you have read, understand, and agree to the above policies:*
Your full name:*
Other Adults Name(s) in Household
Street Address:*
City, State, Zip*
Phone:*

Area CodePhone Number
Spouse Phone:

Area CodePhone Number
If we need to contact you, is it okay to text?*

Yes, first number onlyYes, second number onlyYes, both numbersNo
E-mail:*
*Email is only used to contact you about the cat you are interested in.
Please make sure your email is correct and you are checking your junk folders for a response. We generally contact by email.
Employer:*
Occupation:*
Spouse/Other Adult Employer:
Spouse/Other Adult Occupation:

List all the people (including yourself) and ages that live in the home, even if temporary or part time. Please fill out completely. Applications missing information will not be considered.*

	Name	Ages
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3
4
5
6
7
8
9
10

Do you live in a*

HouseApartmentCondoMobile HomeLive with Family/FriendHousing Provided by EmployerOther
Do you own or rent?*

OwnRent
Does your landlord allow pets?

YesNo
Are there any restrictions from your landlord or subdivision?

Number of petsSize or weight restrictionsBreed restrictionsNoneOther
*If renting, a letter is REQUIRED from landlord stating pets are okay and what if any restrictions on them prior to adoption. Your application will not be processed further until that letter/email is received.

Landlord letters can be emailed to brokenheartsrescue@gmail.com
If rent, provide name and phone number of landlord:
How long at current residence:*
If less than 5 years, please list previous address:
Do you already have pets living in the home? Even if it is a temporary situation*

YesNo

List current pets living in the home (even if temporary) and all of their information. You may have to scroll to the right. Please fill out completely. Applications missing information will not be considered.

	Cat or Dog	Name	Age	Gender	Spayed or Neutered?	Vaccinations Current?	Size	Breed
1
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If your current animals are not up to date on vaccinations or not spayed/neutered, please explain why.
Any household members allergic to animals? Check all that apply.*

NoYes - CatsYes - Dogs
Are you gone more than 8 hours a day where the cat would be left alone?*

YesNo
Explain why or why not:*
Do your current cats go outside?*

Yes, they live outsideYes, they are inside/outsideNo, they are inside onlyWe do not have a catOther
Where will the adopted cat be housed when gone? Check all that apply.*

InsideOutsideWire Kennel/Room - InsideLoose in the House
Where will the adopted cat be housed when home? Check all that apply.*

InsideOutsideWire Kennel/Room - InsideLoose in the House
Have you submitted an application with another organization in the past year?*

YesNo
If so, who and when?
Have you ever been denied adoption of any furkid from a rescue or animal organization?*

YesNo
If yes, explain:
Who are you adopting this cat for:*

Myself/my family living with meFamily member not living with meSurprise giftGiftOther
Why do you want to adopt THIS cat? *
Have you ever sold/given away/rehomed to someone else a furkid?*

YesNo
If yes, describe the circumstances:
Has a furkid ever passed away in your care?

YesNo
If yes, describe the circumstances:
Do you understand that the cat may not be litterbox trained and, if they are listed as litterbox trained, they may have accidents in a changing environment?*

YesNo
Are you willing to work with the cat on house training/issues that may arise?*

YesNo
Explain any personal situation that may arise to cause you to return the cat:*
If something were to happen to you, do you have a back up plan for the cat? What is that plan and have you discussed it with the person or people?*
Have you considered the expenses of adopting a cat; medical/food/training/toys/etc.?*

YesNo
List two NON-FAMILY personal references:
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship*
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship*
Current Vet:
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
I have read the above information carefully and have filled out this application with true and correct information. I understand that the omission of information and/or failure to answer all questions and sign this application may result in the denial of this application. I further understand that if an untruth is discovered once the application is approved that BHR reserves the right to dissolve this application and reclaim the furkid. INITIAL:*
I understand that unless the cat has papers that all ages and breeds are only an estimate/guess. In addition furkids will be deemed a "mix" even if they exhibit full breed traits. INITIAL:*
BHR has my permission to check the information provided in this application and further investigate if questions arise. INITIAL:*
If my application is accepted, I agree to an in home check and meeting with all members in the household prior to the actual adoption at a mutually agreed upon date by all parties. INITIAL:*
If selected to adopt the cat listed I understand that I will also be required to fill out an adoption contract and pay adoption fees. INITIAL:*
I understand that the adoption selection is based on the cats needs/best suited environment for him/her and that the decision is final and therefore I/we will not argue the decision, however, I may apply for another cat unless specifically stated otherwise by BHR. INITIAL:*
I understand that BHR cannot hold/reserve a cat while waiting on a landlord letter, other documentation, or payment. Nor will I request for the cat to be held without adopting, even for a short period of time. INITIAL:*
If electronically submitting this form I understand that my typed name serves as my signature. INITIALS:*
Electronic Signature:*
How did you find out about Broken Hearts Rescue

PetcoRescue MeFacebookFriend/FamilyBroken Hearts Rescue WebsiteOther
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Broken Hearts Rescue Cat Adoption Application