EmailMe Form - Rescued Hearts Northwest - CATS

Rescued Hearts Northwest - CATS

CAT ADOPTION APPLICATION

NOTE: Submitting this application does not obligate the applicant to adopt an animal, nor does it obligate RHN to approve the applicant.
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Your Name
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Best phone number to reach you (please provide extension if applicable).
Best time to call:
Email *
Would you like to opt in to our newsletter? (We will use your email ONLY for Rescued Hearts Northwest purposes: to let you know about RHN news, volunteer and foster opportunities, events, and of course adoptable pets.)
YES!
No thank you.
Name of cat you are interested in:
What type of cat are you interested in? *
Male
Female
Kitten (under 5 months)
Adult
Long Hair
Short Hair
I want this pet for the following reasons. (Check all that apply) *
As a companion for myself
As a guardian
For a relative or friend
For my spouse
For my children
As a gift
How many people currently reside in your home?
How many children live in your home? *
No children
Number of children:
What are their ages? *
No children
Childrens' ages:
Do they have experience with animals? *
Yes
No
No children
If Yes, please describe. *
No children
Childrens' experience with animals:
What hours are you or someone usually home? Please be specific *
Please select the answer which best describes your living situation: *
House
In a relative or friend's home
Condo
Mobile home
Apartment
Duplex or fourplex
Townhouse
** Approval for a pet by the property owner must be verified. If you rent, we will contact your landlord. WE MUST HAVE YOUR LANDLORD'S NAME AND CONTACT INFORMATION ON THIS APPLICATION **
Do you rent or own your residence? *
Rent
Own
Landlord's Name
First Last
Landlord's Phone Number
### - ### - ####
Landlord's Email
If you rent, does your lease allow pets? *
If you rent, do you have a monthly or yearly lease? *
If you rent, when does your lease expire? *
I am the property owner
Lease expiration date:
How long have you lived at your current address? *
Are you a student? *
Full-time
Part-time
No
Where will this cat be kept when no one is home? *
Indoors only
Outdoors only
Both in/out
If outdoors, will the cat be *
attended
unattended
collar & tags
Will anyone be home during the day? *
yes
no
How many hours will the cat be left unattended? *
When no one is home, where will the cat be kept? *
If you move, what will you do with the cat? *
How far from the road/traffic is your home/farm located? *
Is the volume of traffic *
light
moderate
heavy
Do you have other pets (including farm animals)? *
Yes
No
If you have a dog, is he/she permitted to run loose? *
Yes
No
If Yes, what kinds, and what are their breeds? *
No other pets
Brief description of other pets:
How many? *
No other pets
Number of animals:
What are their ages? *
No other pets
Animals' ages:
How long have you had them? *
No other pets
Duration of pet ownership:
Are your companion animals current on their vaccinations? *
No
Yes
Have you had a pet in your home and/or on your property die of a disease such as distemper, feline leukemia, or parvovirus? *
Yes
No
Not sure
No other pets
If Yes, when? *
No death from these illnesses
Time frame:
Are your other pets spayed and/or neutered? *
Yes
No
No other pets
If No, please explain why *
All my pets are spayed and/or neutered
No other pets
Reason for not spaying or neutering:
What precautions would you take to properly introduce a new cat into your home if you have other animals (a dog, bird, rabbit, another cat, etc.)? *
What will you do if your new cat does not get along with your present companion animals? *
Are you planning on declawing? *
Yes
No
Not sure
Have you ever adopted an animal from a rescue/animal control agency? *
Yes
No
Have you ever had an application rejected for adoption of an animal from a rescue/animal control
facility? *
No
Yes
If yes, please explain. *
Do you feel you can afford the cost of maintaining this pet for his/her lifetime? *
Yes
No
What source of income do you have to make this happen? Check all that apply. *
Job
Public assistance
Other
Since most shelter animals have unknown medical/health backgrounds, are you prepared to provide and pay for any necessary medical treatment throughout this pet's lifetime? *
Yes
No
** A Vet Check is Required. We will contact your veterinarian **
Do you have a regular veterinarian? *
Yes
No
No other pets
If Yes, to which clinic do you take your pet(s)? *
No other pets
No veterinarian established
Veterinarian contact information:
If No, and you currently have pets, please explain why. *
No other pets
Reason for not having a regular veterinarian:
Is your veterinarian willing to spay/neuter this pet by 6 months of age? *
Yes
No
Need to verify
You're Almost Done!
Do you or any family members have allergies to pets? *
Yes
No
Who will be responsible for taking care of this pet? *
How will this pet be cared for when the primary caregiver is out of town? *
Do you have training experience? *
Yes
No
Are you familiar with local animal control ordinances for the area in which you reside? (A volunteer can provide you with local information regarding spay/neuter, licensing fees, etc.)
Yes
No
If something were to happen to the primary caregiver for this pet, is there a long-term care solution in place? Please describe. *
Would there ever be a reason you would give up this pet? *
Please explain why you want a pet at this time, in as many words as you need. THIS IS AN IMPORTANT PART OF YOUR APPLICATION! *
May we visit your home? *
Yes
No
VERIFICATION
By entering my name and the current date below, I certify that the information in this application is true and accurate to the best of my knowledge, and I understand that falsification of this information may be cause for denial of my application or revocation of an Adoption Agreement.

Full Name *
Today's Date *
MM / DD / YYYY