HART cat most interested in:       Application Date:  

Why did you choose this particular cat?  

Your Name:
Street Address:
Apartment No.:
City, State, Zip Code:
Telephone:	(Home)       (Work)       (Cell)
Email Address:	Please enter your email address. Please enter a valid email address.
Confirm Email Address:
	The email addresses must match.

Referred By:  

No. of Children:        Age(s):        In Future:   Yes    No    Unknown

Total number of people currently in the household (include yourself; your family members; roommates; etc.)   

Please list members of household & relationship to you (Roommate, child, husband, mother, etc.):

Do you anticipate a change in who will be living in your home within the next year?    Yes    No

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HOME ENVIRONMENT

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Do you own or rent?   Own   Rent	If renting, does the lease allow cats?   Yes   No Landlord Name:   Landlord Phone:

Area of home:  Rural  Suburban  Urban

Type of home:  Single Family Home  Apartment  Townhouse  Condo 

How long have you lived at this address? 

Do you currently have plans to move to a different home within the next year?   Yes   No

Place(s) of employment of adults in family?       How long? 

Any plans to transfer to another location or change employment in the foreseeable future? 

1. How many hours a day will your HART cat be left alone?  0-5 hrs  6-9 hrs  10+ hrs 
2. Where will your HART cat be kept when alone?
   Outside  Free roam of house  Enclosed kitchen  Basement 
   Other, please explain: 
3. How often do you travel for business and/or pleasure? 
4. Who will care for your cat while you are on vacation/travel? 
5. How will you encourage and reinforce appropriate behavior? 
6. How will you prevent/manage inappropriate behavior? 
7. What do you foresee as normal cat/kitten problems? 
8. Will your HART cat ever be allowed outside?  Yes  No
   If Yes:  Unattended  Attended  Only on a leash 
9. What will you do with your cat if you have to move?
   Find new home  Take cat with me  Take to animal shelter  Return to HART 
   Other, please explain: 
10. I would consider giving my cat back to HART if the following situation(s) were to arise (Please check all of the following that you think might apply):
    If my work schedule changes dramatically and I no longer have sufficient time for the cat
    If I have children in the future and no longer have sufficient time for the cat because of the demands of parenting
    If someone in the household becomes allergic
    If I become ill and can no longer take care of the cat
    If I lose my job
    If I divorce or separate from my spouse/partner
    If my new significant other/spouse doesn't like the cat
    If the cat sheds excessively
    If the cat scratches/damages my furniture
    If the cat aggressively scratches/bites people
    If the cat has litter box accidents
    If I move to a home that doesn't allow pets
    If I relocate out of state/out of the country
    Other: 
    Comments: 
11. Where will the cat sleep at night? 
12. Where will the cat eat? 
13. Where will you keep the litter box? 
14. How often would you scoop the litter box? 
15. What behavior(s) would cause you to get your HART cat declawed? 
16. Do you currently have a Dog?   Yes  No
    If Yes, is the dog cat-friendly?  Yes  No  Unknown 
    If No, do you plan on getting a dog in the future?  Yes  No  Unknown 
17. Do you have a doggy door?   Yes  No
18. Do you have a fenced yard?   Yes  No

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FINDING THE PERFECT MATCH

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1. Who will be the primary/sole caretaker of the cat? 
2. Why do you want a cat?  Friend/Companion  Company for other pet  For children  Mouser  Office 
3. What age most appeals to you?  Kitten  Young adult  Adult  Senior 
4. What aspect of a cat is MOST important to you? 
5. What activity level MOST appeals to you?  High  Medium  Low 
6. Type of Coat:  Long  Short  No preference 
7. Is someone in the family willing to brush your cat often?   Yes  No 
8. Does anyone in your family have allergies to dander/hair?  Yes  No  Unknown 
9. How much do you think it costs ANNUALLY to own a cat?  $
10. How often would you take your cat to the vet? 

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PET HISTORY

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1. Have you ever owned a cat or dog?  Yes  No 
   If Yes, please list:

   Name of Pet	Cat/Dog	Breed	If cat, declawed?	In what year did you get this pet?	Total # years pet with family?	Was pet spayed or neutered?	Is pet still with your family?	If no, what happened to the pet?
   	Cat Dog		Yes No			Yes No	Yes No
   	Cat Dog		Yes No			Yes No	Yes No
   	Cat Dog		Yes No			Yes No	Yes No
   	Cat Dog		Yes No			Yes No	Yes No
   	Cat Dog		Yes No			Yes No	Yes No

   Please tell us where your pets came from (breeder, shelter, pet store, rescue group, stray, friend):
   
   If you have owned more pets than listed here, please inform the HART representative that contacts you.
2. What vet(s) have you used most recently/regularly with your pets? Please provide vet contact information for each of the pets that you've owned within the last five years, even if some/all of these vets are out of state:

   Vet or Clinic Name	Phone Number (required)	Pet(s) Names Seen By This Vet

3. Have you ever had to give up a Pet (Cat/Dog/Other) for any reason? Yes  No 
   Please select what happened to the pet.
   If Yes, what happened to the Pet:
   Took to local shelter
   Found new home
   Returned to breeder/rescue
   Other   Explain: 
   Comments: 

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Will you permit a home visit by a HART Representative?  Yes  No 

Do you authorize a vet reference check by a HART Representative? Yes  No 

Have you ever applied to adopt from HART before? Yes  No 

Have you ever adopted from HART before? Yes  No 

How did you hear about HART?
Newspaper   Friend   Internet   PetSmart   PetCo
Other: