BLOEMFONTEIN KITTY HAVEN

APPLICATION FORM / HOME CHECK REQUEST FORM

This form must please be completed in full and then e-mailed/faxed to: Sanchen E-mail: happypets@vodamail.co.za / Fax2mail: 086 618 0456 Cell: 072 406 9077 : NAME OF PET APPLYING FOR : Date of application : Name and Surname : ID Number / Date of birth : Physical address where the animal will be kept : Cell No. : Home Tel. No. : Work Tel. No. : E-mail address : Is someone home during the day? If YES, please specify Is this person capable of caring for your pets while you are away from home? : Family Vet details : Other animals at home (please specify breed and also indicate whether they are sterilized or not) Is your dogs used to cats (will also be checked when homecheck is performed?) THE FAMILY : Number of people and ages of children in the household : Are you planning to move soon, and if so, whereto

: Do you breed with any of your pets : Where will the pet sleep at night : Where will the pet spend time in the day : Who looks after your pets when you go away : What kind of pet are you looking for (i.e. characteristics, size, age, type) : Please provide us with a reference person (not living at the same address Name, Address, Contact number, Relationship) with above mentioned PROPERTY INFORMATION : Do you rent or own the property : Garden size (approximately) : Type of fencing around property : If you rent or live in sectional title unit, do you have permission to keep a pet PET DETAILS YOU ARE APPLYING FOR : Name : Puppy/dog/kitten/cat : Male / Female : Breed : Where did you hear about the animal you are applying for ADOPTION FEE DETAILS Please note that we charge an adoption fee of R100.00 per cat/dog. It only covers deworming. The pet should be returned for sterilization/ castration. Should thing NOT WORK OUT, this pet MUST be returned to BLOEMFONTEIN KITTY HAVEN only.

This also serves as a return-policy.

FOR OFFICE USE ONLY : Home check done by : Approved (YES / NO) : Are there any specific conditions that must be met first : General / Other comments

___________________________ Applicant

___________________________ Witness

___________________________ Sanchen Grobler (Owner Bloemfontein Kitty Haven)