First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

Why are you interested in adopting at this time?*

What traits are you looking for in a pet cat?
Choose all that apply: Cuddler Dependence Energetic Independence Kid friendly Lap cat Lazy Playful Serious Sidekick

What is the name of the cat you are interested in adopting?*
Choose an animal: Acorn Addie Almond Brooklyn Bud Cashew Chaz Chestnut Chip Cobbler Coconut Dilly Fauna Ginger Ginger Ale Goose Granger Heidi Henry Hoku Izzy Jack Katan Kiptyn Klaus Koko Leigh Lilo Lucy Lou Max Mongongo Myrtle Neville Otis Payson Piñon Rolls-Royce Roo Shorty Sid Sir Milo Sirius Snoop Dog Snowball Specter Susie Tango Tay Tay Wachiwi Yuki Zinnia Zuri

Will the cat be allowed outdoors? Please explain*

How much time will the cat spend alone during the day?*

Including yourself, how many adults reside in your household? List names, ages and relationships*

Are there any children living in the home or who visit frequently? If yes, list ages.*

Are all members of your household on board with adding a new pet to the family?*

Who in the household will care for the pet?*

Does anyone living in your home smoke cigarettes or vape?*
Choose one: Yes, both inside and outside the home Yes, only outside the home No

In what type of home do you live?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home?*

If you rent, have you received the approval of your landlord to have a dog?

If you rent, please enter your landlord's name and phone number

What Veterinarian (clinic name and phone number) do you use for your current pet(s)? If you do not have any current pets, please list the vet you plan to use or if unsure, just write "unsure".*

Do you currently have pets?*

If yes, please list your current pet’s breed, age and gender

Are all dogs and cats in your home currently spayed or neutered? *

If one or more of your pets are not fixed, please describe why.

Please list your current pet’s diet and/or PLANNED diet for your new pet including brand of food and type (kibble, canned, freeze-dried, home-made, raw, etc)*

Please tell us about your past pets and/or experience with companion animals (For example, what type of pet? How was your pet obtained? How long did you have it? etc.).

How did you hear about Healing Hearts Rescue?
Choose one: HHR website HHR event Pet adoption website (Petfinder, Adopt-a-pet, etc.) Facebook Instagram Twitter Referral from a person Previous adopter Other

I want to stay connected so I can help save more lives through rescue. Please sign me up for Healing Hearts Rescue emails

If for any reason you cannot keep your adopted pet, do you agree to return him/her to Healing Hearts Rescue?*

What are the reasons you might consider returning your adopted pet back to our rescue?*

Is there any other information you would like to provide us with?

Personal Reference 1: Please list the name, phone number, email and relationship to you*

I certify that the information entered on this applicant is true. Enter your NAME and DATE.*