Name of animal(s) you wish to adopt
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Date
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MM
DD
YYYY
Applicant Name
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First Name
Last Name
Applicant Age
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Applicant Occupation
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Place of Employment
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Co-Applicant Name
First Name
Last Name
Co-Applicant Age
Co-Applicant Occupation
Place of Employment
Phone
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(###)
###
####
Alternate Phone
(###)
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Email
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Do you rent or own your place of residence?
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Rent
Own
How long have you lived at your current address?
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If you rent, do you have your landlord's permission to have a pet?
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Have you paid the pet deposit?
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Name & phone number of landlord
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Number of adults in household
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Number of children in household
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Age(s) of children
Does any family member have pet allergies?
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Are there any smokers in your home?
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Have all members of household had experience with cats?
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Please tell about experience:
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Why do you wish to adopt a companion animal?
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Please check all that apply.
If surprise gift, for whom?
If there are others living in your home, how do they feel about bringing a cat into the household?
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Do you have a fenced yard?
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Do you have a pet door?
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How many times have you moved in the last 5 years?
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Do you plan to move in the next year?
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If you move to a new residence, will you take your pet(s)?
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What would you do with your pet(s) if you had to move to a place that did not allow pets?
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Do you travel?
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If yes, how often do you travel?
Who cares for your pets when you travel?
Who will be the primary caregiver(s) for your pet?
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Do you have any health issues that could affect your ability to care for a companion pet?
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Can you provide a permanent home (average 15 years) for a companion pet?
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What major lifestyle changes do you anticipate in the next 15 years?
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(This is the average life expectancy of a companion pet.)
Where will the animal spend its days?
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Where will the animal sleep at night?
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Where will you keep a litter box?
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What would you do if your cat stopped using its litter box?
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How will you handle a cat's need to sharpen its claws?
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Have you ever had a cat with behavioral problems?
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If yes, how did you handle those behavioral problems?
If your cat is injured, develops a chronic illness or has a serious medical problem, what will you do?
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Has a cat died in your home of feline distemper, leukemia, FIV, FIP, or unknown cause in the last 3 months?
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Under what circumstances would you give up a pet?
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If you had to give up your pet, what would you do with it?
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Have you ever given up a pet?
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If yes, what did you do with it?
How much do you expect to pay annually for pet care (including veterinary care, food, litter, etc.)?
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Do any of your current pets spend any time outdoors?
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Will you allow your cat to go outdoors?
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I would prefer:
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What kind/brand of food do you plan to feed your cat?
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Will you agree to allow a scheduled visit to your home by a rescue professional?
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Veterinarian's Name
Veterinarian's Phone Number
(###)
###
####
Veterinarian's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Reference #1
*
Please include their name, relationship to you, and their phone number.
Reference #2
*
Please include their name, relationship to you, and their phone number.
If the following is true, please check the box and skip to the bottom of the form.
Cat/Kitten #1 Name
Approximate age of cat/kitten #1
Check all that apply for cat/kitten #1
Cat/Kitten #2 Name
Approximate age of cat/kitten #2
Check all that apply for cat/kitten #2
Dog/Puppy #1 Name
Approximate age of dog/puppy #1
Breed of dog/puppy #1
Check all that apply for dog/puppy #1
Dog/Puppy #2 Name
Approximate age of dog/puppy #2
Breed of dog/puppy #2
Check all that apply for dog/puppy #2
Do you have additional companion animals not included above?
If yes, please tell us about them.
DIGITAL SIGNATURE
*
I attest that the above information is accurate.
First Name
Last Name
