Cat Adoption Application Online Cat Adoption Application Step 1 of 6 16% We realize that adopting a new furry friend can be very exciting and emotional, as it’s such an important and life-changing decision! Because of this, we are very thorough in our adoption process, making every effort we can to find the best possible match for a forever home for each of the animals here at the Humane Society of Harrisburg Area, Inc. Please understand that we do reserve the right to deny an adoption application based on our discretion to place our animals in the best possible home environment. Again, please answer ALL questions. Incomplete applications will cause your application to be delayed or denied. Your Driver’s License or Photo Identification Card is required which reflects your current address.Let's Get StartedName of the Cat for which you are applying*Is this your first experience owning a cat?*YesNoHave you owned this breed before?*YesNoTell Us About YourselfName* First Last Birthdate* Date Format: MM slash DD slash YYYY Please note: in order to be considered an adopter, you must be at least 18 years of ageYour Age*Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Place of Employment. If unemployed, please write "unemployed"*Employer Phone. If unemployed, please write "(111) 111-1111"*If unemployed, or a student, please list your source(s) of incomeList the names and ages of any persons living with you, and their relationship to youIndividual 1 First Last Individual 1 AgeIndividual 1 RelationshipIndividual 2 First Last Individual 2 AgeIndividual 2 RelationshipIndividual 3 First Last Individual 3 AgeIndividual 3 RelationshipIndividual 4 First Last Individual 4 AgeIndividual 4 RelationshipPlease list any additional family members belowDoes anyone in your household have cat allergies?*YesNoAre they on medication for it?*YesNoNot applicableHave any members of your family ever been charged with and/or convicted of Animal Cruelty?*YesNoHave you ever adopted an animal from a shelter before?*YesNoIf yes, what was the name of the shelter?Have you ever taken an animal to a shelter before?*YesNoIf yes, why? Tell Us About Your HomeDo you currently*OwnLive with RelativesRentRent to OwnSingle-FamilyTownhome or CondoApartmentMobile HomeLong-Term Hotel/Motel RoomIf living in a Long-Term Hotel/Motel Room, please list name and locationAre you willing to provide proof of a mortgage/home ownership?*YesNoNot ApplicableIf you rent your home, please list the name and phone number of your landlord*If Not Applicable, please write "N/A"How long have you lived at this location?*Tell Us About Your Other PetsPlease note that any current animals living in your home must be up-to-date on their Rabies and Distemper vaccines in order for the staff at the Humane Society of Harrisburg Area to accept your adoption application. In addition, vaccines can take a maximum of five days to be effective in providing protection to your pet. Therefore, we enforce a strict five day waiting period between the time your current animals are vaccinated and the ability for an HSHA animal to be adopted into your home. Please list other animals currently in your home.Animal #1 NameAnimal #1 SpeciesAnimal #1 BreedAnimal #1 AgeAnimal #1 SexMaleFemaleIs Animal #1 spayed/neutered?YesNoAnimal #1 Temperament with PeopleAnimal #1 Temperament with Other AnimalsAnimal #2 NameAnimal #2 SpeciesAnimal #2 BreedAnimal #2 AgeAnimal #2 SexMaleFemaleIs Animal #2 spayed/neutered?YesNoAnimal #2 Temperament with PeopleAnimal #2 Temperament with Other AnimalsAnimal #3 NameAnimal #3 SpeciesAnimal #3 BreedAnimal #3 AgeAnimal #3 SexMaleFemaleIs Animal #3 spayed/neutered?YesNoAnimal #3 Temperament with PeopleAnimal #3 Temperament with Other AnimalsPlease list any additional animals below Tell Us About the Pets You've Had Before!DogsCatsOtherAnimal #1 NameAnimal #1 SpeciesAnimal #1 BreedAnimal #1 AgeAnimal #1 - why do you no longer have this pet?Animal #2 NameAnimal #2 SpeciesAnimal #2 BreedAnimal #2 AgeAnimal #2 - why do you no longer have this pet?Animal #3 NameAnimal #3 SpeciesAnimal #3 BreedAnimal #3 AgeAnimal #3 - why do you no longer have this pet?Please list any additional animals below Tell Us About Your Plans for This CatWill this cat be an*Outdoor Cat (cat will live freely on your property)Indoor Cat (cat will live inside the home)Outdoor/Indoor Cat (cat will live outside part of the time)If cat will be Outdoor/Indoor, please describe belowWhat will be the primary residence for the cat?*Fenced YardInside the HomePatio/PorchGarageBasementOutdoor KennelBarnWho will be responsible for the daily care of this cat?*How many hours will this cat be left alone?*Where will this cat stay when you are not at home?*Will there be an adult home during the day?*YesNoIf so, who?Where will this cat sleep at night?*What do you do - or plan to do with your animal(s) while you are on vacation?*How much money do you expect to spend on this cat each year (this includes a minimum of annual check-ups, grooming, vaccinations, and food)?*If you had to get rid of this particular cat, what would you do?*Why do you wish to adopt this particular cat? (Select all that apply)* Companion for You/Spouse Companion for Child/Children Companion for Other Pet It will be a gift Replace Lost/Deceased Pet Mouser Barn Cat Breeding Other If cat is a gift, for who?If other, please explain Personal ReferencesPlease do NOT list family membersReference #1 Name* First Last Reference #1 Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference # 1 Phone*Reference 1 Email*Reference #1 Relationship to You*Reference #2 Name* First Last Reference #2 Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference #2 Phone*Reference #2 Email*Reference #2 Relationship to You*Your VeterinarianTo expedite the application process, please provide us with proof of your current pets' up-to-date vaccine records/documentation. If this is your first pet, please list the veterinarian you plan to see for the care of your cat.Attach pets' vaccination records/documentationUntitled* I have attached my pets' vaccination records above My vet or myself will fax vaccination records to you at 717-564-1867 I do not have any pets at this time Are your current pets up-to-date on vaccines?*YesNoNot applicableIs your name listed as the Primary Owner of the listed pet(s) with the Vet or Clinic's Office?*YesNoNot applicableIf you answered No, who's name is listed as the Primary Owner?Veterinarian's Name*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone* Acknowledgement & ReleasePlease place a check mark next to each statement confirming your agreement and understanding* I understand that the Humane Society of Harrisburg Area, Inc. is not able to give any guarantees on the health, training, or temperament of this animal and that the adoption fee(s) is not refundable under any circumstances. I understand and accept that authorized Humane Society of Harrisburg Area, Inc. agents sometimes will do follow-up visits to an adopter’s home to check on the care the animal is receiving and can remove the animal if unsatisfied with the viewed conditions. Unanswered questions, incomplete answers, and/or false information may result in this animal’s Adoption Application being denied. The Humane Society of Harrisburg Area, Inc. reserves the right to refuse adoptions. I/We give permission for the Humane Society of Harrisburg Area, Inc. and/or their agents to verify this information through any available means I/We certify that the aforementioned information is true and correct to the best of my/our knowledge. Would you object to an authorized agent of the Humane Society of Harrisburg Area, Inc. inspecting the animal(s) and premises where the animal will be kept?*YesNoPlease enter your name below as your electronic signature
