Cat Adoption Form Step 1 of 4 - Applicant Info 25% Date Date Format: MM slash DD slash YYYY Applicant Name First Last License #Co-applicant Name First Last License #Address Street Address City State / Province / Region ZIP / Postal Code (PO box unacceptable) Applicant Email Home PhoneCellWorkApplicant AgeCo-applicant Email Co-applicant HomeCellWorkCo-applicant Age Living SituationHouseApartmentCondoMobile HomeDo you own or rent your home?OwnRentIf you rent, please provide copy of lease agreement and/or pet rider and complete the following line:Landlord or property manager’s name and phone number:How long have you lived at this address? Will this be your first cat?YesNoWhat kind of pets have you had in the past?Which of these do you still have? (Include name, age, sex and breed.)Have they been spayed or neutered?YesNoDon't KnowAre they current on vaccinations?YesNoDon't KnowHave your cats been tested for feline leukemia?YesNoDon't KnowHave your cats been tested for FIV?YesNoDon't KnowAre your cats declawed?YesNoIf yes, where is the cat declawed?Front pawsAll four pawsWho is your veterinarian?Name of PracticePhoneCity/StateWhat happened to the pets you no longer have?Have you ever surrendered any of your animals to a shelter?YesNoIf yes, please explain:Have you ever had a pet euthanized?YesNoIf yes, please explain:If you have pets, will they adjust to a new cat in the house?YesNoDon't KnowWhy do you want this cat?CompanionCompanion for other petHouse petBarn catMouserOffice catHow many adults are in your family?How many children?Children’s ages?Does any member of your household have an allergy to cats?YesNoIs someone home during the day?YesNoIf yes, who?How many hours each day will the cat be without human companionship?Please explain:(Please consider adopting 2 cats if there is no-one home all day)Where will you keep the cat?In the houseOutdoorsWith free access both indoors and outdoorsIn the barnPlease explain:Do you have a cat or dog door?YesNoWill you have the cat declawed?YesNoMaybeAre you aware of the potential side effects of this operation?YesNoWill you keep the cat up-to-date on vaccinations?YesNoIf you go away for a few days, or on a vacation, who will take care of the cat?If you move, will you take the cat with you?YesNoAre you aware that cats can live 15 to 20 years and are you willing to take responsibility for this cat for the next 10 to 20 years?YesNoIf no, explain:What provisions will you make for the cat should you become unable to care for him/her? Personal Reference 1 First Last RelationshipAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Personal Reference 2 First Last RelationshipAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail
