HART - Harrisburg Animal Rescue Team
Adoption Application
HART-harrisburganimalrescueteam.org
hartrescue10@gmail.com
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Full Name
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Address
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City
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State
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Zip
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How long have you lived at this address
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Home Phone Number
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Cell Phone Number
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Email address
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Employer
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Best Way to Reach You (text preferred)
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Cell
Text
Email
HomePhone
Cat(s) interested in:
Cat(s) second preference:
Please note: Current adoption fee is $100 for one and $175 for two.
All cats/kittens have been spayed or neutered, feline leukemia tested and are current on vaccinations.
Do You Rent or Own your home
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Number of Adults in Home:
Number of Children in Home:
If you Rent, Landlord Contact Information:
Landlord Name:
Landlord Address:
Landlord Phone:
What other pets do you have:
Current Veterinarian - if you do not have a veterinarian, please list your parent's veterinarian. List name, phone number, and name of current and/or deceased pet(s):
Veterinarian:
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Veterinarian Phone:
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Current and/or deceased Pets:
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References: Please list name/address/phone of 2 personal references who have knowledge of you and your pet(s):
Name
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Address
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Phone
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Name
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Address
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Phone
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Have you ever given up or surrendered a pet to an animal welfare organization (explain) ?
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How did you hear about HART?
Do you have any comments for us?
Signature
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Date
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