Heartland Cat Rescue & Adoption Society, Inc.
Membership Application
Membership Fee: $10.00/year.
Add 1 other family member for $5.00 more.
(Checks/Money orders to be made out to: Heartland Cat
Rescue & Adoption Society, Inc.)
(All members must be 18 years of age or older.)
Name:__________________________________D.O.B. _____/____/_______
Address:________________________________________________________
Phone (Day) __________________________ (Evening)____________________
Email:___________________________________________________________
Best time to be reached:______________________________________________
How would you like to help Heartland Cat Rescue & Adoption Society,Inc.?
(Please check all that apply)
( ) Help our volunteers/members feed and watch over the stray cat colonies
in
Highlands County, Florida.
( ) Volunteer at local events that we participate in (festivals, comunity
garage sales,
donation/information booth etc.)
( ) Foster cats or kittens for us until a permanent home can be found.
(Highlands
County residence only.) (Background check is
required before approval)
( ) Volunteer in other ways. ( Please explain)________________________________
____________________________________________________________________
____________________________________________________________________
( ) Donations only. Please check all that apply: ( ) Monthly
( ) Semi-Annual
( ) Annually ( ) Other: ________________
Please tell us about yourself:
What are your interest? ________________________________________________
Do you have any pets? If yes, please explain (dogs, cats, birds, reptiles,etc.)
___________________________________________________________________
___________________________________________________________________
If you do not currently have any pets, Please tell us about any experience you do have
with animals._______________________________________________________
__________________________________________________________________
__________________________________________________________________
If you wish to foster cats or kittens please provide us with the name of your Veterinarian._____________________________
Phone:_____________________
References: (At least 2 and please include phone number)
__________________________________________________________________
__________________________________________________________________
Have you ever surrendered an animal to a shelter or animal control? (Please explain
the circumstances):___________________________________________________
___________________________________________________________________
___________________________________________________________________
By signing below you agree that all information on this application is true and complete
and that you fully understood all the questions. Heartland Cat Rescue & Adoption Society reserves the right to refuse
any application they deem unsatisfactory.
Signature: ______________________________ Date_______/______/________
Please mail your completed application and check to:
Heartland Cat Rescue & Adoption Society, Inc.
C/O S.Rankine, President.
2103 Flower Terrace
Sebring, FL 33875
