Hants & Surrey Border Branch
Cats and kittens application form
Ref no / Interviewed by / DateSurname / Click here to enter text. / Mr/Mrs/Miss/Ms/other / Click here to enter text. /
Address / Click here to enter text. /
Click here to enter text. / Postcode / Click here to enter text. /
Tel (home) / Click here to enter text. / Tel (work) / Click here to enter text. /
Mobile phone / Click here to enter text. / Best time to contact / Click here to enter text. /
How many people live in your household? / Click here to enter text. /
Adults (over 18 years) / Click here to enter text. / Relationship / Click here to enter text. /
Children / Click here to enter text. / Children ages / Click here to enter text. /
Is there likely to be a change
in the near future (new baby)? / Click here to enter text. / Are there any children who regularly visit the property? / Click here to enter text. /
Is the above address:
house / maisonette / bungalow / flat (which floor) / Click here to enter text. / Other / Click here to enter text. /
private / tied / private rent / HM Forces / Council/housing trust
Is there access to a private garden? Yes No / Do you have a cat flap fitted? Yes No
If no, are you willing to get one fitted? / Yes No
Is the accommodation on: quiet road road with rush hour traffic busy main road railway line
Are you due to move or have you booked a holiday within the next six months? / Click here to enter text. /
Do you work full/part time? / Full Part / Hours worked per day / Click here to enter text. / Days worked per week / Click here to enter text. /
On average how long would your
cat be left on its own, and why? / Click here to enter text. /
Any medical problems in your family affected by animals (eg allergy)? / Click here to enter text. /
Have all members of the family/household been in contact with cats? / Click here to enter text. /
Have you owned a cat before? / Yes No
If yes, for how long and what type is it? / Click here to enter text. /
Are there any other pets? / Click here to enter text. /
Have existing animals lived with cats? / Yes No
Name and location of your veterinary surgeon / Click here to enter text. /
Are you prepared to cover the cost of boarding your cat when you are away?
(Approximate cost £7 per day) / Yes No
Are you prepared to seek veterinary advice on routine vaccinations, worming and flea control and to cover the costs incurred for treatment given?
(Approximate cost – annual booster £32, worming and flea control £50 per year) / Yes No
Are you in agreement that a volunteer makes a pre-home visit? / Yes No
Have you proof of your address? / Click here to enter text. /
A post-home visit will take place approximately one month after adoption where proof of vaccination will be required.
Details of cat (RSPCA office to complete)Ref no / Name / Breed
Age / Sex / Colour
Reason and date of entry
Details and personality of cat:
Date of neutering/dental check
Ready to collect from
End of reserve
RSPCA H&SB June12