HART Hoopeston Animal Rescue Team CAT ADOPTION QUESTIONNAIRE It is our policy to make certain that each person who adopts a cat is aware of the responsibilities of pet guardianship, and is capable of and willing to accept those responsibilities morally, physically and financially. Not every person who desires to adopt a cat should do so. By completing this questionnaire, you will aid us in determining if you and your family are indeed ready for pet guardianship and if the cat of your interest would suit you and your lifestyle. Should you agree that adopting a pet is a commitment throughout the lifetime of your companion animal, please fill out this questionnaire. Be aware that completing this questionnaire and turning it in is no guarantee of approval for adoption. * * * * * * * * * * * * * * * CAT(s) of Interest: PERSONAL INFORMATION Date: Name: Age: Facebook Name: Name of spouse partner roommate: Street Address: City: State: Zip Code: Home Phone: Work Phone: Cell Phone: Email: Occupation: Spouse Occupation: Work Schedule: Spouse Schedule: Names of all persons living in your household, their relationship to you and ages: Please list two personal references: (Other than Family Members) Name: Relationship: Phone: Name: Relationship: Phone: pg. 1 updated: January 5, 2016
YOUR HOME Type of dwelling? House Apt Condo Other Own Rent? If condo, what are the association s rules about pets? Your home has: one story two stories If you have a yard: Fenced (height: inches) Unfenced Does your home have a swimming pool? Yes No Pool fenced? Yes No Would you allow an inspection of your home by a rescue volunteer? Yes No If you do not own your home, do you have the landlord s permission to have a Cat? Yes No Will you provide a letter from your landlord, on letterhead, giving permission to have a Cat? Yes No Landlord s Name: Phone: YOUR COMPANION ANIMALS Do you presently have a Cat? Yes No Have you previously had a Cat? Yes No If you presently have or had Cats in the past, please complete the charts below. In the column what happened, write: gave away, sold him/her, took to the pound, abandoned, died, etc. (If the cat died, please state the cause of death.) CURRENT CAT(S) Name & Breed Age Sex Spay/Neutered? How & Why Obtained? How Long? PREVIOUS PET(S) Breed Age Sex Spay/Neutered? Kept In/Out What Happened? Year Have any of your cats ever had kittens? Yes No If yes, do you breed for: Fun Profit Show Accident? Has any member of your family ever experienced animal-related allergies? Yes No pg. 2 updated: January 5, 2016
If you have other pets, please complete the following: Species How Many? Ages Kept Where? Since what year? If cat, de-clawed? Your family veterinarian(s): (Under what Name Used, and what pet(s) name used) Name: Phone: YOUR NEW DOG Who would be responsible for the care of the Cat? What is your primary reason for adopting a cat? Companion Other If Companion, whose? You Spouse Children Other pet Someone else (who?) Where will the cat sleep? Inside (where? ) Outside (where? ) How many hours per day will the cat be left alone? Hours Where will the cat be left when he/she is alone? Indoors Outdoors If outdoors: Yard Patio Garage other If yard: Do you have a pet door? Yes No When you are at home, the cat would be: Indoors Outdoors other Which rooms or areas of the home/yard will be off-limits to the cat? Do you allow cats on furniture? Yes No Some (which? ) If the cat will be outside at all, what outside space is available for the cat? Yard Patio Balcony Unfenced yard other Are the gates: Latched Padlocked other Do you travel a great deal? Yes No How often? How long at a time? When you travel, how do you intend to provide for the cat while you are gone? pg. 3 updated: January 5, 2016
What provisions would be made for the cat if you had to move: Locally: Out of state To a place where no pets are allowed? Under what circumstances would you not keep the cat? Divorce Illness in family Moving New baby New job Housetraining problems Chewing Crying Digging Allergy Shedding too much Kids ignore the cat Pets didn t get along Not obedient enough Other (explain ) Would not give up for any of above reasons If the cat becomes destructive at your home, what would you do? If the cat has accidents at your home, what would you do? If the cat shows Separation Anxiety, what would you do? If the cat becomes aggressive to people and/or other cats, what would you do? * People Aggression: * Other cat aggression: If the cat becomes ill or injured, are you financially prepared to provide the medical care? Yes No If yes, is there a maximum amount you would spend for your cat s medical needs? Yes $ Reason? No State provision: The cat may live 15+ years. What would you do with your cat if you could no longer care for them? Is there anything else you would like to tell us about yourself? pg. 4 updated: January 5, 2016
PLEASE UNDERSTAND THAT IT IS AGAINST OUR POLICIES FOR ANY ADOPTER TO DECLAW OUR CATS OR KITTENS. Please sign here that you understand this policy and agree not to declaw your new cat or kitten EVER! X * * * * * * * * * * * * * * * Questionnaire Information: All the information I have provided in this Questionnaire is true and accurate to the best of my knowledge. If any of the information changes, I will advise you promptly. Signature: Date: Print Name: ***PLEASE ALLOW 7 DAYS FOR THOROUGH PROCESSING OF APPLICATIONS. APPLICATIONS ARE APPROVED BASED ON BEST MATCH, NOT FIRST COME-FIRST SERVE. THANK YOU FOR YOUR PATIENCE AND UNDERSTANDING. ***Please review your application to ensure that it is filled out accurately and honestly, an incomplete application will cause delay or cause the application to be disqualified. Dis-honesty will automatically will automatically null and void any adoption of an animal. *** No person will be allowed to adopt any animal that has Felony convictions, and/or Domestic Violence charges or convictions. pg. 5 updated: January 5, 2016