Adoption Application Form

Helderberg Animal Rescue Team

Adoption Application Form
Name of kitten/cat/puppy/dog applying for*
for example - Tasha
are you applying for a kitten/cat/puppy/dog? *
for example - kitten
Full Name*

First NameSurnameIdentity Number
E-mail*
Cell Phone Numbers/Work Number*

Work numberCellphone
Address*

Street Address

Street Address Line 2

CityProvince

Post Code

Please list all pets, age, breed, sex, sterilised or not, where they sleep at night, kindly note that we do not allow any animal to be adopted to a home with unsterilised dogs or cats. Our puppies must sleep inside the house and have free range of the house and garden. Please click on each box to complete.

	Name	Age	Type/Breed	Male/Female	Sterilised	Sleep inside/outside
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

If you have any unsterilised dogs/cats, would you be willing to sterilise them? If you answered NO, please note that under the City of Cape Town by-laws we cannot adopt any animal to homes where there are unsterilised animals*

yesno
If you have cats/kittens - have they been tested for feline aids and feline leukemia

YesNo but they are vaccinatedNo and not vaccinated
Have you had a sick pet on your property in the last 6 months?*

YesNo
If yes, please explain circumstances*
N/A if no
Have you ever had to give up a pet?*

yesno

Have you ever adopted a pet before?*

yesno
If yes, who did you adopt through?*
N/A if no
Who would be responsible for your pets daily care?*
How many hours a day would your pet be left alone? Puppies and kittens need supervision if younger than 4 months (kittens) 6 months (puppies) and may not be left alone for longer than 1 to 2 hours, do you have a plan for this, please explain what?*
If you have no other pets and work long hours, would you be willing to adopt another kitten or puppy ?*

YesNoN/A
Where will the pet stay when alone?*
Where will the pet stay at night?*
Where will the pet stay during family trips/vacations?*
Our kittens and puppies currently eat Royal Canine, Omega, Vets Brand or Eukanuba , would you be willing to feed the same quality veterinary food? Please bear in mind that supermarket foods may cause health or growth issues.*
Yes or No

If there are young children in the home please be aware when adopting kittens/cats/puppies and dogs that there are a number of important points to remember.
- Having a puppy/dog is like having another child
  Dogs/Puppies require constant training and supervision from an early age, affection, exercise, stimulation, companionship/constant attention. They must sleep inside the house and have a garden to play in.
  Lifetime commitment +- 15 years
  Puppies nip, jump up, scratch and love to chew – that is normal!!!
- Cats/kittens do sometimes destroy furniture/belongings. We strongly advise buying a cat scratch post and lots of toys.
- Kittens should preferably be kept inside until they are sterilised.
Vet's Name*
Vet's Phone Number*
Reference #1 Name*
Reference #1 Phone Number*

It is hereby cerfified that in the event of this application being approved, the applicant agrees to the following conditions and has understood that they have agreed to/will abide by these conditions*
I Agree

I agree to bring the adopted animal to HART's approved vet to be sterilised - female kittens at 4 months old, male kittens at 5 months old, puppies at 6 months old (the cost of this is included in the adoption fee) - failure to abide by this rule, I understand that the animal will be removed from my care and that I will have no recourse to reclaiming the animal.*
I Agree
I agree that should the pet fall ill within 10 days of adoption with a deadly infectious disease (e.g. parvovirus, distemper, snuffles), I/we will notify HART IMMEDIATELY. Feedback is important so that the necessary steps can be taken to remedy the situation. If the vet confirms that the pet fell ill as a result of its stay with HART, the organisation undertakes to pay the account, within reason. The applicant understands that HART is not liable for any medical expenditure occurring after the pet has been out of HART’S care for 10 days or more.*
I Agree
The applicant undertakes to keep the new pet properly enclosed (preferably indoors) for a timeframe as long as may be required for the new pet to become accustomed with its new surroundings – the timeframe for such enclosure may vary from a couple of days to a couple of weeks, depending on each pet. All gates and fences must be secured and escape proof*
I Agree
The applicant understands that the pet MAY NOT be chained or fastened under any circumstances and must be allowed full access to the available property / yard.*
I Agree
The applicant agrees to random checks by HART in order for this organisation to confirm that the pet is receiving suitable housing and care. The applicant understands that HART has the right to remove the pet should the applicant fail to comply with the rules and regulations as stipulated in this document. *
I Agree
I/we agree that in the event of me/us being in breach of any of the terms and conditions that we will be placed on a 14(FOURTEEN) day written notice to rectify the breach.*
I Agree
I/we fully and completely agree that should I/we fail to rectify the breach as per the written instruction to do so, and that should HART deem it necessary. I/we will give up all rights to the animal and will surrender the animal back to HART with no objections or actions taken in any way to prevent this from happening. I/wewill have no recourse against HART for this. I/we agree and accept that this is a legally binding consent.*
I Agree
The adopted cat/dog must remain in the custody and possession of the Adopter. The Adopter may not sell, trade, give away or dispose of this pet in any way. If the Adopter cannot keep this cat/dog for any reason, THEY MUST NOTIFY HART IMMEDIATELY. THE ANIMAL MAY NOT BE SURRENDERED TO ANY OTHER ANIMAL WELFARE ORGANISATION. The onus will be on the owner to find a new loving home for the pet that HART needs to approve. We will need to do a house inspection etc to ensure the new home is satisfactory. HART will try and assist with finding a new home if possible. *
I Agree
I/we agree to the jurisdiction of the courts of the area I/we live in and that I/we will be liable for any costs incurred by HART, legal or otherwise should I/we breach any of the terms and conditions of this agreement. *
I Agree
I/we agree to pay the adoption fee of R1100.00 to HART only once a home check has been conducted and the adoption has been approved. I/we understand that the adoption fee payable is not a purchase price, but fee which covers the veterinary medical expenses incurred by HART in order to place the animal in my care and that the animal has been checked and found to be healthy before rehoming. I/we understand that this fee is NOT refundable or transferable. *
I Agree

ONCE YOU HAVE CLICKED ON THE SUBMIT FORM BUTTON ABOVE, YOU WILL RECEIVE AN ACKNOWLEDGEMENT MESSAGE.

THANK YOU FOR YOUR APPLICATION - KINDLY NOTE THAT WE ARE A VERY SMALL TEAM OF VOLUNTEERS AND HAVE FULL TIME DAY JOBS, IF YOU DO NOT RECEIVE A RESPONSE WITHIN 24 HOURS PLEASE CONTACT US VIA WHATSAPP ONLY ON 0768210465 TO REQUEST AN UPDATE - THANK YOU
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Helderberg Animal Rescue Team