Adoption-Form - Hermitage Cat Shelter

Personal Information

Do you rent or own?*

Rent

Own

How long have you lived at this address?*

If renting, please list Landlord's name*

Landlord's Phone

Employer*

How long have you been employed at your current job?*

Please describe what you do at your job?*

How many people are living in your household?*

How many children are in your household?*

Does anyone in your household have allergies to cats?*

If so, how will you handle this?*

Are you a member of the Active Military or Reserves?*

Yes

No

If so, what will you do with your cat upon deployment?*

Are you a student?*

Yes

No

If so, where is your hometown?*

What will you do with your cat during school breaks and upon graduation?*

Please complete if you have not already fallen in love with a particular cat so that we can help!

Age of cat desired:*

Sex of cat desired:*

Cat hair preference:*

Cat hair color preference:*

Why do you want this cat?*

Is this cat a gift?*

If yes, does this person reside in your house?*

Yes

No

Please list all pets you currently have along with names, breed and age*

If you have a dog, do you have a doggie door?*

What other pets have you had in the past and what happened to them?*

Have you ever had a kitten before?*

If yes, where are they now?*

Have you ever had to turn a pet into a shelter or re-home it before? If yes, please explain*

If you currently have cats, have they been tested for FeLV and FIV before?*

Yes

No

Unsure

Are they declawed?*

Yes

No

Unsure

Why were they declawed?*

Where will your cat live?*

Indoors only

Outdoors only

Indoor & Outdoor

Do you have a fenced in yard?*

Yes

No

Do you have a veterinarian now?*

Yes

No

Please list veterinarian's name:*

Do you intend to have your new cat declawed?*

Yes

No

Unsure

Are you aware of the alternatives to declawing?*

Yes

No

If you cat becomes seriously ill or injure and requires expensive veterinary care, how will you handle this?*

What is your contingency plan in the event you may become physically unable to care for your cat?*

How will you discipline your cat?*

Are you prepared to make a lifetime commitment to your new cat?*

Yes

No

If your cat doesn't use the litter box appropriately are you willing to take them to the vet to determine if it is a medical or behavioral problem and are you willing to try to solve the problem?*

Yes

No

If you travel, how will you care for your cat?*

How did you hear about us?*

Please list any information you would like us to know about you:*

Please provide 2 personal references of people who know how you care for animals and will be willing to talk to us about that:

Reference One Name:*

Reference One Relationship:*

Reference One Phone #*

Reference One E-mail Address:*

Reference Two Name:*

Reference Two Relationship:*

Reference Two Phone #*

Reference Two E-mail Address:*

Do you want to Opt-In to receive email communications from Hill’s Pet Nutrition?*

YES

NO

By submitting this application I attest that the information I have provided is true and I understand that giving false information will result in my application being denied. The Hermitage No Kill Cat Shelter reserves the right to deny the adoption of a cat to anyone that the Hermitage feels will not provide a loving and responsible home for that animal. I understand that this application is property of The Hermitage and I authorize investigation of all statements in this application, references, landlord approval and background. Check if you understand.*

I understand