Adopter Cat Screening Application
We are Paw Obligated to Check You Out!
Today's Date
Name of pet you are applying for (if known)
Will you allow a Hurricane Pets representative to do a home visit
select one
Yes
No
Why do you want to adopt
select one
Pet
Gift
Breeding
Other
If "other" checked above please explain
Your Name
full name
Date of birth
(Over 18)
Address
City
State
Zip Code
Email
a valid email
Home Phone #
ex: (555) 555-5555
Mobile Phone #
ex. (555) 555-5555
Employed
select one
Yes
No
Retired
Self Employed
Employer Address
Type of Residence
Select if you rent or if you own and type of residence.
Rent
Own
Live with parents
Live with roommates
Apartment
House
Condo
Townhome
Mobile Home
How long have you lived at your present address
Are you planning to move soon
Yes
No
If planning to move soon, when?
Do you live in a high rise building
Yes
No
If checked "Yes" above. What Floor?
Do you have a balcony
select one
Yes
No
If yes, is your balcony screened
Yes
No
Do you have a backyard
select one
Yes
No
If yes Is your backyard fenced
select one
Yes
No
Landlord Name
ONLY IF YOU RENT
Landlord Tel. #
(555) 555-5555
Landlord E-Mail
Landlord permission to have a pet
select one
Yes
No
Landlord’s Initials for Consent to have a pet
Landlord Signature
Type and Number of pets allowed
ADDITIONAL INFORMATION
Number of adults in your family
# of Children
If Children Specify Ages
Have you ever gotten a pet for your children as a Christmas present
select one
Yes
No
If the answer to the above is yes, where is the pet now?
If adopt a pet, who will be the primary caregiver for the pet?
Is anyone in your home allergic to pets?
select one
Yes
No
Will the pet be:
select one
Inside
Outside
Both
If you adopt a cat, where will you place the litter box?
Do all members of your household agree to this adoption?
Yes
No
Do you or anyone in household smokes?
select one
Yes
No
If the answer above is "Yes", do you smoke:
select one
inside
outside
indoors and outdoors
Are you financially able to care for a new pet?
select one
Yes
No
Will you provide vet visits and ensure yearly vaccines?
select one
Yes
No
Would you consider declawing your new friend?
select one
Yes
No
Have you ever owned a declawed cat?
select one
Yes
No
If the answer above is "Yes", did you have the cat declawed?
select one
Yes
No
Which word or words best describes your home/lifestyle?
select all that applies
Laidback
High-energy
Quiet/calm
Bustling
Noisy
Busy
Not home much
Home all the time
INFORMATION ON YOUR CURRENT & PREVIOUS PETS.
List all current Pets Below:
Pet # 1: Name
Species
ex. Dog, Cat, Rabbit, etc.
Age & Years owned?
Where is this pet now?
Is your pet Spayed/Neutered?
select one
Yes
No
If the answer above is "No", please explain.
Pet # 2: Name
Species
ex. Dog, Cat, Rabbit, etc.
Age & Years owned?
Where is this pet now?
Is your pet Spayed/Neutered?
select one
Yes
No
If the answer above is "No", please explain.
Pet # 3: Name
Species
ex. Dog, Cat, Rabbit, etc.
Age & Years owned?
Where is this pet now?
Is your pet Spayed/Neutered?
select one
Yes
No
If the answer above is "No", please explain.
Additional Pets
List them here.
If your current pets are cats are they tested for FELV and FIV?
select one
Yes
No
Have you ever had to surrender an animal to a shelter?
select one
Yes
No
If the answer above is YES, please explain:
VETERINARIAN INFORMATION
Veterinarian’s Name:and Last Name:
Address:
City:
State
Zip Code:
Phone #:
ex. (555) 555-5555
Fax #:
ex. (555) 555-5555
Email
a valid email
PET RELATED
What would you do if the pet scratches or chews on furniture:
What will you do if the pet urinates on the furniture or carpet:
What would you do, if a new boyfriend or girlfriend moves in with you or you get married or re-marry and you find out that your new partner is allergic to the pet?
What will you do with the pet if a new baby arrives?
How many times a day would you feed your pet?
What type of food would you feed your pet?
select one
Wet Food (can)
Dry Food (kibble)
If you travel who will take care of the pet in your absence?
Will you return the animal to Hurricane Pets if you can no longer take care for it:
select one
Yes
No
In a DISASTER (hurricane, tornado, earthquake, etc.), would you leave your pet alone at home if you had to go to a shelter?
select one
Yes
No
Please explain what would you do with the pet, in the event of a Mother Nature or Man made disaster ?
Please provide a personal reference not related to you below.
Name and Last Name:
full name
Telephone #:
ex. (555) 555-5555
Email
a valid email
WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT - PLEASE READ INITIAL AND SIGN BELOW:
I understand there is an adoption fee that varies with the description of the animal I adopt. Medical and possibly other records on the animal being adopted will be provided at the time adoption, it is the adopter responsibility to keep these records and to give this information to their veterinarian. If an animal is too young to be neutered/spayed you must agree to have that done within a reasonable amount of time before the animal becomes old enough to breed, per your veterinarian. You must send us proof of spay/neuter in the form of a record from your veterinarian. No animal adopted through us may be used for breeding purposes.
Half of your adoption fee is required to hold an animal and is not refundable if the adopter does not follow through with the adoption through no fault of ours or the animal.
INITIAL HERE
Adoption fees are NOT REFUNDABLE once the pet had been adopted.
INITIAL HERE
All animals must be returned to Hurricane Pets if the adopter cannot longer keep them (may be placed elsewhere subject to our approval). All adoptions are not the same and we will make every effort to work with adopters, we want you and our animals to be happy.
Applicant Signature:
Sign Electronically.
Date
Today' Date
Please send the application back to us via e-mail, if you have trouble with the application format please e-mail us @ HPRESQ@aol.com we will help you with the process.
FOR OFFICE USE ONLY
Hurricane Pet Representative
Case Manager
Approved / Denied
Approval or Denial Date
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