Describe the cat/cats you are looking to adopt

Would you consider a special needs cat or kitten?

Yes      No 

• If Yes, explain

First name

Last name

Address

City

State

ZIP

Home Phone

Mobile Phone/Pager

FAX number

E-mail Address

Place of Employment

Work Number

Where and when is the best time to contact you? (At home, at work, etc.)

Do you already own pets?

Yes      No 

• If Yes, list breed, sex and age

Are your current pets spayed or neutered and up to date on shots?

Yes      No 

• If No, why not?

Has/have your current cat/cats been tested for FeLV and/or FIV?

Yes      No 

• If No, why not?

• If Yes, when, and what were the results?

Your Veterinarian’s Name

• Veterinarian’s Address

• Veterinarian’s Phone

Where will this cat stay?

Inside only 
Outside Only
Both Inside and Outside 

Do you own or rent your home?

Own      Rent 

What type of dwelling is it?

Single-Family House 
Apartment 
Condo 
Other 

• Landlord’s name, if applicable

• Landlord’s phone

• What is your Landlord’s pet policy or lease requirements for pets?

• Amount of pet deposit

• Has it been paid?

Yes      No 

Name and ages of all children living with you

Have you ever owned a cat?

Yes      No 

When?

• If Yes, where is it now?

• Were you the one responsible for it’s care?

Yes      No 

• If not, who was?

Will you be the one responsible for the new cat’s care?

Yes      No 

• If No, who will?

What do you plan to do when the cat does things like:  climb curtains, scratch furniture, or jump on counters or tables?  

Describe how you plan to discipline the cat?

By signing here and/or returning this application you are excepting all responsibilities involved with adopting a cat/cats, will allow the verification of your information, and you understand that no cat will be given to your care until your information has been checked, a home interview or visit is made with all of your household members present and you have met all the qualification to complete the adoption.  Furthermore, you understand that you may be turned down with or without a reason.  You agree that, should you meet the qualifications now and receive a cat/cats, but cease to meet the qualifications in the future or otherwise not be able to properly care for it/them, you will contact the original owner and return the cat to them or to whom they designates at that time.  You will not, under any circumstances, give the cat/cats to anyone else or any organization, rescue group, animal control agency, etc.

Electronic Signature (Type Name):


Date (Type Date):