Pet Harbor Rescue & Referral, Inc.
. . . a port in the storm for Virginia's & the greater D.C. metro area's homeless Siberian Huskies and cats . . .

(703) 583-HSKY
adopt@petharbor.org

If you are applying to adopt a CAT, this is the right application.
If you are applying to adopt a DOG, go to Dog Application.

Process
Home
FAQ
Cat Adoption Application
Please note: If you submit an application & don't hear from us within 48 hours, please write webmaster@petharbor.org.

Congratulations for wanting to adopt a homeless pet. This is our application, not a contract to adopt. This is the first step in the process, as noted on the Adoption Process page. A successful adoption depends on finding the perfect pet for you & the perfect permanent home for the pet. So please be as complete & honest as possible. We apologize the application is long, but it is necessary to get as much information as possible to make the right match. When finished, submit the form online, mail, or fax.
PLEASE NOTE: (1) WE RESERVE THE RIGHT TO VISIT THE HOME WHERE THE CAT WILL LIVE PRIOR TO ADOPTION.
(2) WE RESERVE THE RIGHT TO APPROVE OR DENY ANY ADOPTION FOR ANY REASON AND THE RIGHT TO NOT DISCLOSE THE REASON.
(3) YOU MUST BE AT LEAST 18 TO APPLY.
Do you understand and agree to the above notice? Yes No

When answer choices are offered, please check all that apply. Please be as specific as you can.

Basics:
Has anyone in your house ever been convicted of an animal-related charge? Yes No
How soon do you expect to adopt?
What date are you prepared to take a kity home?
How did you find out about us?
Please understand it takes a great deal of our volunteers' time to process an application. Please be sure you are ready to adopt from us when applying. If you are applying to adopt at other rescues, what are the rescues' names?

Before you answer the following questions, please familiarize yourself with our adoption procedures and our contract requirements.

Do you understand donations are tax-deductible and are not refundable? Yes No
What is a method of payment for the donation Pet Harbor will not accept?
What is the minimum donation amount required to adopt the cat you want to adopt?
Per the contractual requirements, what must you do with the cat if can no longer keep him/her?
How long are you required to keep in touch with us and keep your contact information current with us?
Do you object to volunteers investigating and/or inquiring concerning the cat's circumstances after adoption? Yes No

About You:
Your first and last name
Street address
City State Zip Code
What county do you live in?
If anyone in the house has an occupation that involves animals in any way, what is it?
Home phone Cell phone
Your work phone Other resident adult work phone
E-mail

About Your Family:
How many adults live in the house?
First and last names of other adult residents in the house
How many people under age 18 live in the house?
What are the ages of those under 18?
What is the name of the cat's primary caregiver?
Is anyone in the house allergic to any animals? Yes No Unsure
If you answered "Yes" or "Unsure," how will you avoid allergic reactions?
Is everyone in the household aware of and agreeable to your adopting a cat? Yes No Unsure

About Your Home:
Type of home: Home setting: How long have you lived at this address?
If you have a property owners' association, what are the restrictions it has regarding pets?
If you sometime have to move where cats are not allowed, what will you do with this cat?
If military, what are your plans for your pet if you are deployed?
Do you have future plans to move? Yes No If yes, how soon?
Do you: Own Rent Live with family Other
Landlord's name: Landlord's phone number:
NOTE: If you rent, we will verify you can have this cat. Also we require you have written permission to have this pet. We will need that permission faxed to us.
When you go to the vet, will you carry the cat in a carrier or hold him/her? Carrier Hold

References:
Please list your veterinarian & 3 personal references we may contact. We prefer they be people who know your experience with animals. Please list one relative. Do not put people who live in your house. Note: We cannot call people who do not accept private calls.
Veterinarian
If you have no current veterinarian, please list your most recent vet, no matter where located.
Name
Phone
Reference #1
Reference #2
Reference #3
Name Name Name
Relationship Relationship Relationship
Phone Phone Phone
E-mail E-mail E-mail

Pet Ownership:
Have you owned any cats in the past 5 years you no longer own? Yes No If yes, please fill in the "Previous Cat Ownership" section below.
Have you owned any dogs in the past 5 years you no longer own? Yes No If yes, please fill in the "Previous Dog Ownership" section below.
Are there cats currently living in your home? Yes No If yes, please fill in the "Current Cat Ownership" section below.
Are there dogs currently living in your home? Yes No If yes, please fill in the "Current Dog Ownership" section below.

Previous Cat Ownership:
Prior Cat #1
Prior Cat #2
Prior Cat #3
Prior Cat #4
Name Name Name Name
Breed Breed Breed Breed
Gender FM Gender FM Gender FM Gender FM
How long did you have this cat? How long did you have this cat? How long did you have this cat? How long did you have this cat?
Where is this cat now? Where is this cat now? Where is this cat now? Where is this cat now?
If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death?
In whose name are this cat's vet records? In whose name are this cat's vet records? In whose name are this cat's vet records? In whose name are this cat's vet records?

Previous Dog Ownership:
Prior Dog #1
Prior Dog #2
Prior Dog #3
Prior Dog #4
Name Name Name Name
Breed Breed Breed Breed
Gender FM Gender FM Gender FM Gender FM
How long did you have this dog? How long did you have this dog? How long did you have this dog? How long did you have this dog?
Where is this dog now? Where is this dog now? Where is this dog now? Where is this dog now?
If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death? If the pet is deceased, what was the cause of death?
In whose name are this dog's vet records? In whose name are this dog's vet records? In whose name are this dog's vet records? In whose name are this dog's vet records?

Current Cat Ownership:
Current Cat #1
Current Cat #2
Current Cat #3
Current Cat #4
Name Name Name Name
Breed Breed Breed Breed
Gender FM Age Gender FM Age Gender FM Age Gender FM Age
How long have you had this cat? How long have you had this cat? How long have you had this cat? How long have you had this cat?
Is this cat spayed or neutered? Yes No Is this cat spayed or neutered? Yes No Is this cat spayed or neutered? Yes No Is this cat spayed or neutered? Yes No
If not, why not? If not, why not? If not, why not? If not, why not?
Is this cat declawed? Yes No Is this cat declawed? Yes No Is this cat declawed? Yes No Is this cat declawed? Yes No
Has this cat interacted with cats before? Has this cat interacted with cats before? Has this cat interacted with cats before? Has this cat interacted with cats before?
Yes No Yes No Yes No Yes No
Does this cat go outdoors? Yes No Does this cat go outdoors? Yes No Does this cat go outdoors? Yes No Does this cat go outdoors? Yes No
In whose name are this cat's vet records? In whose name are this cat's vet records? In whose name are this cat's vet records? In whose name are this cat's vet records?

Current Dog Ownership:
Current dog #1
Current dog #2
Current dog #3
Current dog #4
Name Name Name Name
Breed Breed Breed Breed
Gender FM Age Gender FM Age Gender FM Age Gender FM Age
How long have you had this dog? How long have you had this dog? How long have you had this dog? How long have you had this dog?
Is this dog spayed or neutered? Yes No Is this dog spayed or neutered? Yes No Is this dog spayed or neutered? Yes No Is this dog spayed or neutered? Yes No
If not, why not? If not, why not? If not, why not? If not, why not?
In whose name are this dog's vet records? In whose name are this dog's vet records? In whose name are this dog's vet records? In whose name are this dog's vet records?


About the Cat You Want to Adopt:
If there is a particular cat you are interested in, what is that cat’s name?
What about this particular cat sparks your interest?
Are you interested only in that cat? If yes, skip down to "Other Information." Yes No
What gender(s) are acceptable to you? Male Female Either
If you have a gender preference, please explain why.
Youngest acceptable age?
Oldest acceptable age?
If you have an age preference, please explain why.
What length(s) of fur are acceptable to you? Short Hair Medium Hair Long Hair Any Length Hair
What color(s) coat is acceptable to you?

Please explain how important it is to you that the cat already have the following traits when he/she first gets to your house.
Always uses litter box Unnecessary Trainable Preferred Essential
Nondestructive Unnecessary Trainable Preferred Essential
Good with babies Unnecessary Trainable Preferred Essential
Has no medical issues Unnecessary Trainable Preferred Essential

Other Information:

Please understand since we don't know you, these answers are all we have to try to match you with a cat. The more explanatory, the better.
How much do you think it will cost you to care for this cat for one year? $ Can you afford it? Yes No
If some catastrophic thing happens, such as your cat accidentally gets out and gets hit by a car and the veterinarian tells you "He'll be fine, but it will cost thousands of dollars to fix," financially how will you handle it? PLEASE BE SPECIFIC.
How will you discipline your pet?
How will you handle finding a potty accident you did not see the cat have?
There is NO perfect cat. Just like humans, cats make mistakes. For example, a cat who always uses a litter box might stop using the box. If the cat you adopt makes mistakes after he comes to your house, what will be your course of action?
If you decide you no longer want the cat, what will you do with him/her?
Do you plan to declaw this cat? Yes No Will he/she be confined to the indoors or allowed outdoors? Indoors Only Will Go Outdoors
If you become pregnant, who will change the litter box?
How many hours will this cat be alone (without humans) during the day? Who will care for the cat when you vacation?
Where will the cat be when you are not at home? Where will the cat sleep?
Have you considered any health problems or risks to which you may be exposing your current pets? Yes No
Have you ever released a pet to an animal shelter? Yes No
Have you given away a pet? Yes No
Have you ever sold a pet? Yes No
If yes to any of the last 3 questions, what were the circumstances?

Comments:
Please let us know any other information you wish us to consider in placing a pet with you. Here is your chance to personalize this application.
Your interest is deeply appreciated because every cat or cat we can place is one less that is homeless, hungry, abused, or killed.
By indicating yes and submitting this form, I signify that all information given in this application is true and correct, to the best of my/our knowledge. And by indicating yes and submitting this form, I hereby further grant consent to Pet Harbor and its volunteers to seek information about me from all named and unnamed sources within this application, including but not limited to veterinarian, rental agent, personal references, to assist in the application process. Yes No

PET HARBOR WOULD LIKE TO THANK YOU FOR TAKING
THE TIME TO COMPLETE THIS APPLICATION.

Good Dogs and Cats Deserve Second Chances