HOAP Cat Form

Submission of this form does not guarantee acceptance into the program. Acceptance into the program does not guarantee that the cat will be placed.

Date:
Your Name:
Street Address:
Apartment No.:
City, State, Zip Code:
Telephone:   (Home)       (Work)       (Cell) 
Email Address:  
   
Confirm Email Address:
 
Where did you get the cat?
How long have you had him/her?
Why do you want to surrender your cat?
How long can you keep the cat?
If stray, where was the cat found?
 


Cat Name:      Breed:      Age:
Gender:      
Fur Length:   
Coat color/markings:          Eye color:
Declawed:      
Spayed/Neutered:         If unaltered female,give date of last heat:
Is cat good with?          If yes, ages:
Has the cat snapped, bitten, or
shown aggressive behavior toward:
              
Please describe the
above incident(s):
Does the cat spend time
indoors or outdoors?
     

Has the cat ever destructively clawed
anything (furniture, drapes, carpeting)?
  
Does the cat have and use a
scratching post or scatch box?
  
Has the cat ever urinated/sprayed/defecated
outside of its litter box while indoors?
  
Please describe the above incident(s):
Has the cat ever killed rodents or birds?   
Does the cat sleep with you in bed at night?   
Please check all that apply:
How often do you feed your cat?
What sort of food does the cat eat?      
Any special dietary needs/preferences?
Name and phone of vet:
Dates of last vaccinations:
Rabies:
FVRCP (Distemper):
Other (please list):
Has your cat ever been tested for
Feline Leukemia Virus (FeLV)?
  
  If Yes, was the cat found to be carrying the FeLV virus (FeLV+, aka FeLV positive)?
  
Has your cat ever been tested for
Feline Immunodeficiency Virus (FIV)?
  
   If Yes, was the cat found to be carrying the FIV virus (FIV+, aka FIV positive)?
  
Does the cat suffer from any medical
problems? (If so, please describe
and include medications)
Does the cat have any behavioral
problems or bad habits that a
new owner needs to be aware of?
Does the cat have any particularly
interesting/endearing behaviors?
Additional comments?
Have you contacted the
HART office already?
  
Do you authorize a vet check
by a HART representative?
  
Will you permit a home visit
by a HART representative
to see this cat?
  


When you click Submit, your application will be forwarded to the HOAP Coordinator. You will also receive an automated email copy of this application. Please print this email copy and save it for your records.

  

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