Hoopeston Animal Rescue Team

H.A.R.T.

Hoopeston Animal Rescue Team

CAT ADOPTION QUESTIONNAIRE

901 West Main Street, Hoopeston, IL. 60942

217 283 0779 or 765 414 6586

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.

- If your current pets are not spayed or neutered, chipped,up to date on shots or your dog is not on a heart worm prevention medication please do not apply! We feel strongly that all companion animals should be spayed and neutered and chipped andthat their vaccinations must be current for the health of the pet.

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.

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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:

______

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Please list two personal references: (Other than Family Members)

Name: ______Relationship: ______Phone: ______

Name: ______Relationship: ______Phone: ______

YOUR HOME

Type of dwelling? House Apt Condo  Other ______

Own  Rent? If condo, what are the association’s rules about pets? ______

Your home has: onestory 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

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  Unfencedyard 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? ______

______

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? ______

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If the cat has “accidents” at your home, what would you do? ______

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If the cat shows Separation Anxiety, what would you do? ______

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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? ______

 NoState 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______

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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.

pg. 1 updated: January 5, 2016