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H.A.R.T.

Hoopeston Animal Rescue Team

901 West Main Street, Hoopeston, IL. 60942

217 283 0779 or 765 414 6586 hartshelterteam@

CAT ADOPTION QUESTIONNAIRE

List the cat(s) of interest in order of priority (If you wish to adopt more than one cat, please use "and")__________________________________________________________________________________

Your Full Name ________________________________

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. 

Before you complete this application, please note the following: 

If you are a first time pet owner, please expect extended processing time. Please make sure you provide all documents that you think will aid in your application process. Documents include, but are not limited to, other family members vet records, proof of pet-sitting or pet experience, etc.

( I am a first time pet owner and I understand the statement above.

( I am not a first time pet owner.

Please note that providing vet records will expedite the adoption process.

( I do not have any vet records.

( I understand the statement above and I have provided my vet records.

PERSONAL INFORMATION Date: ____________________

Name: ________________________________________ Age:

Facebook Name:__________________

Name of θ spouse θ partner θ 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: ______________

YOUR HOME

Type of dwelling? θ House θ Apt θ Condo θ Other ________________________________________

θ Own θ Rent? If condo, what are the association’s rules about pets? __________________________

Your home has: θ one story θ two stories

If you have a yard: θ Fenced (height: _____ inches) θ Unfenced

Does your home have a swimming pool? θ Yes θ No Pool fenced? θ Yes θ No

Would you allow an inspection of your home by a rescue volunteer? θ Yes θ No

If you do not own your home, do you have the landlord’s permission to have a Cat? θ Yes θ No

Will you provide a letter from your landlord, on letterhead, giving permission to have a Cat? θ Yes θ No

Landlord’s Name: ___________________________________ Phone: ___________________________

YOUR COMPANION ANIMALS

Do you presently have a Cat? θ Yes θ No Have you previously had a Cat? θ Yes θ 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? θ Yes θ No

If yes, do you breed for: θ Fun θ Profit θ Show θ Accident?

Has any member of your family ever experienced animal-related allergies? θ Yes θ No

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?

θ Companion θ Other _______________

If Companion, whose? θ You θ Spouse θ Children θ Other pet θ Someone else (who?) ___________

Where will the cat sleep? θ Inside (where? _______________) θ 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? θ Indoors θ Outdoors

If outdoors: θ Yard θ Patio θ Garage θ other ___________________

If yard: Do you have a pet door? θ Yes θ No

When you are at home, the cat would be: θ Indoors θ Outdoors θ other _______________________

Which rooms or areas of the home/yard will be off-limits to the cat? ______________________________

Do you allow cats on furniture? θ Yes θ No θ Some (which? ________________________________)

If the cat will be outside at all, what outside space is available for the cat?

θ Yard θ Patio θ Balcony θ Unfenced yard θ other ___________________________

Are the gates: θ Latched θ Padlocked θ other ____________________________________________

Do you travel a great deal? θ Yes θ No

How often? _______________________ How long at a time? ___________________________

When you travel, how do you intend to provide for the cat while you are gone? _____________________

_____________________________________________________________________________________

What provisions would be made for the cat if you had to move:

θ Locally: ___________________________ θ Out of state _____________________________

To a place where no pets are allowed? _______________________________________________

Under what circumstances would you not keep the cat?

θ Divorce θ Illness in family θ Moving θ New baby θ New job θ Housetraining problems

θ Chewing θ Crying θ Digging θ Allergy θ Shedding too much θ Kids ignore the cat θ Pets didn’t get along θ Not obedient enough

θ Other (explain _______________________________) θ 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? θ Yes θ No

If yes, is there a maximum amount you would spend for your cat’s medical needs?

θ Yes $ _______________ Reason? ____________________________________________

θ 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? ___________________________________

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 24 hours to 7 DAYS FOR THOROUGH PROCESSING 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.

Please attach a copy of your driver’s license.

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