Adoption Application for CATS

B-C-D. Contact Information
	B. APPLICANT
b1. First Name:
b2. Last Name:
b3. Age:
b4. Home Phone:
b5. Cell Phone:
b6. Work Phone:
b7. Primary Email Address:
b8. Secondary Email Address:
Important Note:	Please double check that the email addresses you entered are correct. If they are incorrect, we will be unable to reach you!
b9. Street Address:
b9. City:
b9. State:	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
b9. Zip Code:
Mailing Address:	(if different)
b10. Street:
b10. City:
b10. State:	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
b10. Zip Code:
	C. CO-APPLICANT
c1. First Name:
c2. Last Name:
c3. Age:
c4. Cell Phone:
c5. Work Phone:
c6. Primary Email Address:
c7. Secondary Email Address:
	Please double check that the email addresses you entered are correct.
d1. Ages of all other adults and children at your home:
d2. May we visit your home prior to application approval?	YesNo
d3. How long have you lived at your current address?
d4. Do you own or rent?	OwnRentLive with parents in their home

E. Renters: Please provide your Landlord's contact information
e1. Landlord's Name:
e2. Landlord's Address:
e2. Landlord's City:
e2. Landlord's State:	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
e2. Landlord's Zip Code:
e3. Landlord's Phone:
e4. Do you have your landlord's permission to have a cat?	YesNo

F. Please describe the kind of cat you are interested in adopting
f1. Please tell us why you want this pet: Check every box that applies	Companion for me/my family Companion for my other pet(s) Gift for someone else Hunting/mouser To breed Other (please specify below)
f2. Preferred Age:	- Select - Kitten Young Adult Senior Any Age
f3. Preferred Size:	- Select - Small - 5 to 8 lbs Medium - 8 to 10 lbs Large - 10 to 15 lbs 16 lbs and over No size preference
f4. Preferred Sex:	- Select - Male Female No sex preference
f5. Reason for sex preference
f6. Preferred Temperament Check every box that applies	Outgoing - confident Reserved - shy Talkative Independent Calm Playful - energetic Affectionate Lap cat Likes other cats Likes dogs Other (please specify below)
f7. How long are you willing to commit to this cat's care? Check every box that applies	As long as it is young As long as it is healthy As long as it does hunt As long as I am single Until I/we have children For the cat's whole life Other (please specify below)
f8. Would you consider a Special Needs cat, such as one who requires medication for a permanent but controlled condition?	YesNoUncertain

G. Please list all the pets you CURRENTLY own:
Pet #	Pet Name	Species	Sex	Spayed or Neutered	Where did you obtain this pet? State the age and the breed(s).
1:		- Select - Bird Cat Chicken Dog Donkey Ferret Fish Gerbil Goat Guinea Pig Hamster Horse Llama Rabbit Rat Sheep Snake Turtle Other	- Select - Male Female	Yes No
2:		- Select - Bird Cat Chicken Dog Donkey Ferret Fish Gerbil Goat Guinea Pig Hamster Horse Llama Rabbit Rat Sheep Snake Turtle Other	- Select - Male Female	Yes No
3:		- Select - Bird Cat Chicken Dog Donkey Ferret Fish Gerbil Goat Guinea Pig Hamster Horse Llama Rabbit Rat Sheep Snake Turtle Other	- Select - Male Female	Yes No
4:		- Select - Bird Cat Chicken Dog Donkey Ferret Fish Gerbil Goat Guinea Pig Hamster Horse Llama Rabbit Rat Sheep Snake Turtle Other	- Select - Male Female	Yes No

H. Please list all the pets you have owned IN THE PAST starting with the most recent ones:
#	Pet Name	Species	Sex	Spayed or Neutered	Where did you obtain this pet? What happened to the pet? If deceased, state age & cause of death.
1:		- Select - Bird Cat Chicken Dog Donkey Ferret Fish Gerbil Goat Guinea Pig Hamster Horse Llama Rabbit Rat Sheep Snake Turtle Other	- Select - Male Female	Yes No
2:		- Select - Bird Cat Chicken Dog Donkey Ferret Fish Gerbil Goat Guinea Pig Hamster Horse Llama Rabbit Rat Sheep Snake Turtle Other	- Select - Male Female	Yes No
3:		- Select - Bird Cat Chicken Dog Donkey Ferret Fish Gerbil Goat Guinea Pig Hamster Horse Llama Rabbit Rat Sheep Snake Turtle Other	- Select - Male Female	Yes No
4:		- Select - Bird Cat Chicken Dog Donkey Ferret Fish Gerbil Goat Guinea Pig Hamster Horse Llama Rabbit Rat Sheep Snake Turtle Other	- Select - Male Female	Yes No

h5. Have you ever had a pet who

was hit by a car ran away was lost was stolen was poisoned none of the above Other/Please explain

I. Veterinarian Information
	Current or Primary Veterinarian	Former or Secondary Veterinarian
i. Name:
i. Street Address:
i. City:
i. State:	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
i. Zip Code:
i. Phone:
PLEASE CALL YOUR VET(S) AND GIVE CONSENT TO RELEASE MEDICAL INFORMATION POSTED ON YOUR FILE.

J. Your new cat's living conditions
j1. Where will your cat live?	Strictly indoor Mostly indoor with some outdoor Indoor/outdoor Outdoor during the day and inside at night Strictly outdoor
j2. Do you live in	an apartment a duplex a townhouse a condo a single house a farm a mobile home Other (please specify below)
j3. Do you live on/near	a very busy street a busy street a quiet street a cul de sac a country road Other (please specify below)
j4. How would you describe your household?	Active Noisy Quiet Average
j5. Who, other then family members has access to your home when you are not a home? Check every box that applies	Housekeeper Exterminator Babysitter Other (please specify below)
j6. Home features Check every box that applies	Screened porch Fenced yard Doggie door Balcony Screens on all windows Cat fencing Other (please specify below)
j7. Will your cat have free roaming inside your home?	Yes No
j8. Do you plan to declaw this cat?	Yes, front feet only Yes, all four feet No Uncertain
j9. How often will you groom/brush your cat?
j10. Where will you keep the litter box?
j11. How much do you expect to spend on regular health maintenance for your cat in a year? NOT including food
j12. What behavior or circumstances would cause you to give up your pet? Check every box that applies	Not getting along with other pets Shedding Destructive Scratches the furniture Not using the litter box Housetraining problems New baby Pregnancy Divorce Marriage Medical problems Financial problems Children lost interest Allergies Pet not adjusting No time Moving Found a new ''no pets'' apartment Training problems Want to travel None Other (please specify below)
j13. Cats have been known to claw furniture, carpet and drapes, dig in potted plants, etc. How do you plan to deal with these potential problems?
j14. Have you ever sold, given away, or surrendered a pet to a shelter?	Yes No
j15. If yes, please specify why:
j16. Please tell us why you want a cat:
j17. If and when you move, what will you do with your cat?
j18. What will you do with the cat if you can no longer keep him/her?
j19. What plans will you make for the cat during your vacation?
j20. Who will be the cat's primary caretaker?
j21. Who will take care of the cat if something happens to his/her caretaker?
j22. In case you have to evacuate because of a natural disaster, where will your pet(s) stay?
j23. What would you do if the pet becomes very ill?
j24. How far with treatment will you go?
j25. Have you, or any member of your family/household, been cited for leash law violations or cruelty to animals in the past?	Yes No
j26. If yes, please specify:
j27. Is there anything else you would like us to know about your application?
j28. How did you hear about us?

K I/We assert that the information I(we) provided is complete, true and accurate to the best of my/our knowledge. I/We understand that completion and submission of this application does not guarantee adoption of a cat. I/We hereby give permission to contact my/our Veterinarian(s) and Landlord, if applicable. Check this box to confirm

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