Cat Adoption Application This application is for anyone intending to adopt a cat from our organization. Please fill out each section completely and truthfully. * indicates required fieldStep 1 of 425%Application Date* Date Format: MM slash DD slash YYYY # of Cats looking to adopt*123Cat's NameEnter name as it appears on website or adoption card.2nd Cat's NameEnter name as it appears on website or adoption card.3rd Cat's NameEnter name as it appears on website or adoption card.Have you ever adopted from other rescues*YesNoPlease list the rescuesGeneral InformationName* First Last Email* Enter Email Confirm Email Cell Phone*Work PhoneHome PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you own or rent?*OwnRent - HouseRent - ApartmentLandlord Information*Please provide name of the property and/or manager name, and phone numberProof of pet policyPlease provide copy of your lease agreement or some other proof showing that pets are allowed at your place of lease. Drop files here or Accepted file types: jpg, png, pdf.Are you currently employed*Yes - Full TimeYes - Part TimeNoIn betweenWho is your employer?*Explain*Age Group*--please select--Under 1818-2425-3435-4445-5455-6465 or AboveAre you adopting this animal for yourself or as a gift?*MyselfGiftAt NHAR we have a strict policy of not allowing adoption for the purpose of gifting. We encourage that the intended owner is present during the adoption process and completes his/her own application. Thank you for your understanding and cooperation. If you feel this message is being displayed in error, please do not hesitate to Contact UsWe cannot proceed with the application due to age restriction. Thank you for your understanding and cooperation. If you feel this message is being displayed in error, please do not hesitate to Contact UsPlease select valid "Age Group" to proceed.Household General InfoAny Children in the household?*YesNoPlease provide ages of all the Children living with you*Please separate with commasAre you or anyone in your household allergic to pets or have ever been allergic to pets*YesNoPlease explainCurrent Pet InfoHow many pets currently live in your home?*no pets123More than 3What type of pets live with you currently?*select all that applies Cat(s) Dog(s) Farm animals ReptilesDo your current pet(s) live inside or outside?*InsideOutsideCommentsPlease add more info explaining why your pets live outsidePets #1Pet #1 Name* First Dog or Cat?*DogCatAge*Spayed/Neutered*YesNoPet #2Pet #2 Name* First Dog or Cat?*DogCatAge*Spayed/Neutered*YesNoPet #3Pet #3 Name* First Dog or Cat?*DogCatAge*Spayed/Neutered*YesNoOther PetsAdditional petsYou identified that you have more than 3 animals in your home. Please list them here include the the type, age and if they are fixed.Dog(s) Medical InfoAre all your dog(s) current on their vaccinations?*YesNoWhy not?*My dog(s) are on heartworm prevention?*YesNoWhat's the name of the Heartworm medication?*Why Not?*Please provide details why your dog(s) are not on heartworm prevention? Do you take them for annual tests at the vet? If so when was the last test?Cat(s) Medical InfoAre your cat(s) current on their vaccinations?*YesNoWhy not?*My cat(s) have been tested for feline leukemia?*YesNoMy cat(s) haven been tested for FIV (feline immunodeficiency virus)?*YesNoMy cat(s) are declawed*YesNoPrevious PetsHave you owned animals in the past?*Other than your current animals if you have any.YesNoOther than your current pets (listed above) Please list pet(s) you have owned in the last 5 years and their current status:*Please tell us if you have had pets before or this is your first pet.Vet InfoDo you currently have a veterinarian?*YesNoPlease explain*You've identified that you live with or own pets, please explain why you do not currently have a veterinarian.Have you had a Vet in the past?*YesNoPlease explain*You've identified that you have had pets in the past, please explain why you did not have a veterinarian.Vet's Name*Dr's Name or Medical GroupVet's Phone number*Vet's Email General adoption questionsHave your ever rehomed or surrendered a pet?*YesNoPlease explain*Why was it necessary to rehome or surrender your pet?Are you adopting this cat as:*Please check all that apply Indoor House Cat Outside Cat Indoor/Outdoor Cat Mouser Barn Cat OtherExplain (Other)*Do you plan to declaw your cat*YesNoIf you move, what will happen to this and/or your current animals?*What happens to your animal(s) when you travel or go on vacations?*In the event that your pet(s) should outlive you, what arrangements have you considered for your pet?* Family member (please list) Friend (please list) Shelter (which one) Return to New Hope Animal Rescue Other (explain)List or explain*References*** Please provide a name of someone who does not live with you. ***1st Reference* First Last Phone*Relationship*2nd Reference* First Last Phone*Relationship*Adoption Agreement, Consent and SignaturesHousehold Adoption Consent and Declarations* I declare that all adults living at the provided address are aware and are in agreement to adopt this(these) pet(s)* I authorize New Hope Animal rescue to contact my references, including my veterinarian to verify the information I have provided on this application* I understand that if New Hope uncovers any information on this application to be false, that the pet will be reclaimed by New Hope Animal Rescue.* I permit New Hope Animal Rescue to conduct a home visit, which will be scheduled in advance.* I agree that this pet shall not be sold, given, or adopted to anyone else, nor shall it be given to a shelter or other rescue organization. This pet adopted from New Hope Animal Rescue must be returned to New Hope Animal Rescue for any reason if I can no longer keep this pet.* I understand that cats can live up to 20 years and can cost up to $500-$1,500 each year for basic nutrition and vet care. I am willing to accept financial responsibility for this animal.* If this pet is found roaming free more than two times or not kept current on prevention and vaccinations, I understand New Hope Animal Rescue has the right to Reclaim this pet.Declarations* I understand that all animals adopted out from New Hope Animal Rescue will be spayed/neutered as New Hope does not adopt out cats for breeding. If a kitten is not spayed/neutered at time of adoption, New Hope Animal Rescue requires this be done at 4 months of age. Refusal to alter an animal will result in immediate removal from the home.Signature PageApplicant Signature*Type your full nameToday's Date*Enter today's date Date Format: MM slash DD slash YYYY Co-applicant SignatureType your full nameToday's DateEnter today's date Date Format: MM slash DD slash YYYY Authorization Signature* By checking here you to agree to the terms and conditions of this application. *Terms & Conditions: By submitting this application, You are not obligated to adopt. Adoption fees are due at the time of pickup. You attest that the person signing is your true self and all statement are true to the best of your knowledge. PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
