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855345-206375Adoption Application Form020000Adoption Application Form-670560-36957000 Section A: Information Needed For A Home Check PRIMARY APPLICANT INFORMATION:Full name: Cell Number: Home Tel:Work Tel:Home Address:ID Number or Age:Email:Occupation:Company:Usual working hours:PARTNER/SPOUSE INFORMATION:Full name: Cell number:ID Number or Age:Relationship:Do you live together?Email:Occupation:CompanyUsual working hours:Do you have any other pets? If so, please fill out the table below:Cat/Dog/OtherNameMale/FemaleAgeSterilisedBreedMicrochippedSleeps In/Out doorsVeterinarian Information:Practice Name: Practise Address:Office Tel:Previous Pets or Welfare Interactions: Have you previously adopted from another welfare organisation? □Yes □No □ NAIf yes, what is the name of the welfare organisation: Did they conduct a pre-adoption home visit? □Yes □No □ NA Do you have the details of the person who visited you? Name: Contact Number:Have any of your pets died or gone missing recently? If yes, please provide details:Have you ever surrendered a pet to a welfare organisation or rehomed it? If yes, please provide details:Have you ever had an application for adoption rejected by another organised? If yes, please provide details:Section B: Additional Information Needed For An Adoption Application(You are welcome to fill this out with Section A if you wish to be placed on our waiting list)Residence and Family Information:Residence Type (Please tick): □Freestanding house □Semi-detached property □Flat □Other – please describe:Owned?□Yes □NoIf owned, are pets allowed?□Yes □No □ NARented?□Yes □NoIf rented, do you have permission to keep a pet?□Yes □No □ NAIs there a garden?□Yes □NoIf yes, is it a: □Private garden □Communal garden □OtherProximity to a main road:Perimeter Wall/Fencing Height:Is there a swimming pool?□Yes □NoIs the swimming pool covered?□Yes □No □ NADo you have children?□Yes □NoChild’s NameChild’s AgeDo they live with you? If so, how often?Are any of the people that live in your household prone to allergies? □Yes □NoAdoption Information:Name(s) of the animal(s) you are applying to adopt:Why do you want to adopt the animal(s)?Should your pet(s) require it, can you afford after-hours vet fees? □Yes □NoWill anybody be at home with your pet(s) during the day? □Yes □NoWhere will your new pet sleep? Do you confirm that your new pet(s) will be fed Royal Canin food or a veterinary-quality equivalent (i.e. not supermarket brand food)? □Yes □NoWill you allow Raise ‘n Rescue to send your information (details of animal you adopt, your name, address, email and telephone number) to Royal Canin in order for us to receive much needed food donations from them for our rescues? □Yes □NoWould you ever consider emigrating? □Yes □NoIf you do emigrate, what would you do with your pet(s)?If you go away on holiday, what arrangements will you make for your new pet(s)?No kitten under 6 months old should be left alone for long periods of time. If there is nobody at home during the day and there are no other cat companions either, do you agree to adopt two kittens together? □Yes □NoYoung kittens have low immunity, and the stress of joining a new home can sometimes lead to snuffles, diarrhoea, or other symptoms. Do you agree to take your new kitten to the vet as soon as possible, should any of these symptoms affect its health? □Yes □No □NAWill you teach your kitten to use a scratching pole in order to save your furniture? □Yes □No □ NASection C: DeclarationDo you declare that you have read ALL of the requirements of the Adoption Procedure document, and that you consent to the requirements outlined below? □Yes □NoI hereby declare that all the information provided above is true to the best of my knowledge and belief. I agree to pay the required ADOPTION FEE payable, either upfront or upon collection, which is non-refundable, even in the case of the animal(s) being surrendered back to Raise ‘n Rescue at any given time after adoption.I agree to provide the adopted animal(s) with an identity tag.I agree to provide the adopted animal(s) with the veterinary care it requires, including (but not limited to) annual check-ups, deworming at least every 6 months, and vaccination booster shots (many of which will be required soon after the animal joins its new home).I agree to contact Raise ‘n Rescue immediately should the adopted animal(s) fall ill within 7 days of adoption with any infectious disease.I agree that Raise ‘n Rescue has the right to confiscate the adopted animal(s) at any time at their discretion, should matters arise that contradict the agreement of this adoption contract. I also agree that Raise ‘n Rescue can do further post-adoption home-checks at their discretion.I agree that the adopted animal(s) may NEVER be passed onto any other person (including a relative) or organisation without the specific permission of Raise 'n Rescue, neither in the case of the death of the owner or any other imaginable situation.I agree that, should I, at any time MOVE from the address where I now reside, I am to notify Raise 'n Rescue within 7 days. The same applies to telephone and other contact details.I agree that I will bring a CAT CARRIER with me when I collect my new pet.I take notice of the risk of FeLV/FIV and will consider to test my new cat(s) 3 months after adopting them or when they are 6 months old.I agree that all of the information presented by myself, _____________________ (print name) in this Adoption Application form are correct and true, to the best of my knowledge.Signed: _______________________________________ Date: _________________________________Witness: ______________________________________ Date: _________________________________ ................
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