HART of Cincinnati, Inc. Cat Adoption Application
About You
(fields with gray boxes are required)
Your Name:
Street Address:
City, State, Zip:
Phone Number (day):	eg:(513)123-4567
Phone Number (evening or cell):	eg:(513)123-4567
Email Address:
Do you want to be on our e-mail distribution?:	Yes No
About The Cat
Why do you want to adopt?:
Name of Particular Cat you are interested (if any):
Are you currently the foster family for this cat?:	Yes          No
Type of cat you are looking for:
Age Range:
Size:
Gender:
Activity Level:
Where will the Cat be when no one is home?:
Where will the Cat be when someone is home?:
How many hours will the Cat be home alone?:
Will you be letting the cat go outside?:	Yes          No
Where will the cat sleep?:
Have you ever relinquished a pet to a shelter or someone else? (if yes, why?):
About Vet
Do you have a vet?:	Yes          No
Vet Information:
Vet's Name:
Vet's Phone Number:
Number of adults in the household?:
Number of children in the household?:
Ages of Children?:
Do children visit you?:	Yes          No
About Current Pets
What pets do you currently have?:
Names of Current Pets:
Ages of Current Pets:
Are your pets up to date on vaccinations?:	Yes          No          N/A
Approximate date of last vaccination:
Does anyone in your household have allergies to cats?:	Yes          No
What form of prevention will you use if your cat begins to scratch on furniture etc.?:
Other pets you've had in the last 5 years?:
What happened to other pets?:
Additional Information Required
Do you rent or own?:	Rent          Own
If you rent: What is your landlords name?: What is your landlords phone number?: eg:(513)123-4567 Have you contacted your landlord to make sure pet's are allowed?: Yes          No Is there an increase on your rent for housing an animal in your apartment?: Yes          No Is there a weight limit for animals living in your apartment?: Yes          No
What will happen to your Cat if you move?:
Would you agree to a home visit?:	Yes          No
How did you hear about HART?:
We require 2 references: Reference #1 name: Reference #1 Street address:      City: State: Zip: Reference #1 phone number: eg:(513)123-4567 Reference #2 name: Reference #2 Street address:      City: State: Zip: Reference #2 phone number: eg:(513)123-4567