EmailMe Form - Dog Habitat Rescue Cat Application

Pet You Are Interested in: *

How were you reffered to
Dog Habitat Rescue:

Applicant Information

Applicant

First Last

Co Applicant

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone Number

### - ### - ####

Email

What kind of home do you live in?

Apartment

Condo

House

Do you Rent or Own?

Landlord's Name:

Landlord's Phone:

### - ### - ####

How long have you lived here?

Do you plan to move?

Employer:

Employer Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

House Hold Information

Household Yearly Income:

Number of Adults in the Home?

Everyone has agreed to adopting a pet?

Are there any children in the home?

Is anyone allergic?

Why would you like to adopt a pet?

Do you currently have any other pets? If so, tell us about them.

Pet History

Please list Prior Pets Breed, Age, Gender and current Status:

Have you ever given up a pet before? If so what were the circumstances?

Vet Name

Vet Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Vet Phone Number

### - ### - ####

New Pet Information

How long have you been looking?

What are you looking for?

Breed: Purebred, Mix or
No Preference

Age:

Energy Level:

Size:

Coat Type: Long, Medium, Short or Hypo-Allergenic

What will you feed your new pet?

How often will you feed your pet?

Are you able to afford an $200 - $800 vet bill in case of an emergency?

How much do you expect to spend on yearly maintenance?

Home and Family Life

What brand of food will you feed your cat?

Do you have a fenced in yard?

Where is your cat's place at home?

How long would you allow for our rescue to adjust to his new home?

How many hours per day will he/she be alone?

How do you plan to interact with your pet?

Where will your rescue be kept during the day?

And in the evening?

Are you committed to caring for your new pet for 15+ years?

If you have to move, what will you do with your pet or pets?

Do you travel frequently?

Who will look after your pet if you need to travel?

References:

Please list three references, with name phone and relationship:

1.

2.

3.

Signatures

By providing your name(s) below, I certify that the information I have given is true. I understand that Dog Habitat Rescue reserves the right to deny my application for any reason. I further authorize the investigation of all statements in this application.

Applicant

Date

MM / DD / YYYY

Co Applicant

Date

MM / DD / YYYY