First Name: *
Your first Name
Last name: *
What is your last name?
Your age *
Select your age. Valid values are between 21 and 80.
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
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37
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78
79
80
Do you have a firm commitment from another adult to care for your cat if you no longer can? *
Have you arranged for someone to care for a cat you adopt in the event you no longer can?
No Yes
Street Address: *
What is your street address used for mailing
Additional Street Address:
City: *
What is the town or city?
State: *
What is the state?
Zip code: *
What is your zip code?
Primary Phone number: *
What is your primary phone number?
Email address: *
What is your email address?
Is there a coapplicant? *
Is there another person to be included on the application?
No Yes
Coapplicant's Relationship to you: *
What is the relationship between you, the applicant, and the coapplicant?
Parent
Significant Other
Spouse
Roommate
Other Relative
Other
Co Applicant First Name: *
Co applicant's first name:
Co Applicant last name: *
Co applicant (if any) last name:
Co applicant age *
How many cats are you interested in? *
Do you want one or more cats?
1
2
3
4
Are you interested in a specific cat or just a general breed or type? *
Are you interest in a general type of cat or a specific cat on our web site?
Specific
General
Name(s) of animal(s) you are interested in. *
Arrow (Dog - 10242908D)
Atticus (Dog - 11242921D)
Bindi (Dog - 10242909D)
Blondie (Dog - 12242930D)
Cami (Dog - 11242922D)
Casper (Dog - 01232538D)
Charlie (Cat - 05242854K)
Coors (Dog - 10242910D)
Crispin (Dog - 11242929D)
Dash (Dog - 12242931D)
Dilly (Dog - 11242924D)
Emilio (Dog - 11242923D)
Gage (Cat - 06232720C)
Kira (Dog - 12232743D)
Missy/Anastasia (Cat - 08242877C)
Nora (Cat - 11242914K)
Scrappy (Dog - 08212165D)
Stewie (Dog - 11242927D)
Symon (Dog - 11242918D)
Tabitha (Cat - 06232717C)
Taylor (Cat - 05242841K)
Twisty (Cat - 08242871C)
Zoe (Cat - 11242920K)
Choose type of cat you are interested in *
Cat
Kitten
Do you live in a *
apartment
house
condo/townhouse
other
Do you own your residence or rent it? *
rent
own
other
Are you willing to provide written (e.g., copy of lease) or verbal (from landlord) confirmation that you are allowed to adopt this cat? *
Yes
No
Including yourself, how many people are in your residence? *
How many people live the residence?
0
1
2
3
4
5
6
7
8
9
10
Are all your household members willing to confirm that they are in agreement about adopting a cat? *
No Yes
How many members of the household are children? *
0
1
2
3
4
5
6
7
8
9
What are the ages of the children? *
Select ALL that apply
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Is there a possibility that you might move in the next 5 years? *
Do you think you will be moving within 5 years?
No Yes
When you move, is it possible your cat may not be able to come with you? *
No Yes
On average, how many hours per day will the cat(s) be alone? *
Consider time away when you're at work or other regular commitments.
0
1
2
3
4
5
6
7
8
9
10+
Are there pets currently in your household? *
No Yes
What are the species and ages of your current pets? *
Select ALL that apply
dog-1yr
dog-2yr
dog-3yr
dog-4yr
dog-5yr
dog-6yr
dog-7yr
dog-8yr
dog-9yr
dog-10yr
dog-11yr
dog-12yr
dog-13yr
dog-14yr
dog-15+
cat-1yr
cat-2yr
cat-3yr
cat-4yr
cat-5yr
cat-6yr
cat-7yr
cat-8yr
cat-9yr
cat-10yr
cat-11yr
cat-12yr
cat-13yr
cat-14yr
cat-15+
Are all current pets spayed/neutered? *
No Yes
Are your current pets all up to date on yearly vaccinations? (for example, rabies, which is mandatory by law) *
No Yes
Who is your current vet? *
What is your vet's phone number? *
Do we have your permission to contact your vet? *
We contact your vet to confirm that your pets are up to date on vaccines such as rabies.
No Yes
Are you willing to commit to medical care for your cat(s), from annual visits to vaccinations (including rabies), which we estimate can cost an average of $300-$500/yr for healthy cats, and probably much more for aging and ill cats? *
No Yes
How many cats have you owned in the past? *
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
At what age did your previous cats die or leave you? (Include the age of each departed cat.) *
Select ALL that apply
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Select the reason for departure of each previous cat. Additional information can be added at the end of this form. *
Select ALL that apply
old age
cancer
internal organ failure
run over
runaway
outside predator
gave away
other
Have you ever had your cats declawed? *
No Yes
Do you intend to declaw this cat? *
No Yes
Your current cats are *
Indoor only
indoor and outdoor
outdoor only
You intend for this cat to be *
Indoor only
Indoor and outdoor
Outdoor only
Please list the names, addresses and phone numbers of 2 personal references who are not related to you: *
Please provide the name and phone number of someone to contact in an emergency *
An emergency contact name and number
Please feel free to provide any additional information about the information you provided, your situation, your household or environment or anything else pertinent to your application that could help us evaluate your viability as an adopter for our cat(s)
How did you hear about Homeward Bound?
Our website
another website
Friends or family
Referral
Previous adoption from HB
Please enter your name and submit the application: *
