Your Name (required):

Address (required):

City (required):

State (required):

Zip Code (required):

Phone (required):

Your Email (required):

Cat(s) interested in (required):

If interested in kittens, would you be willing to adopt a pair: YesNoNot Applicable

How long have you been looking for a cat:

How many hours are you away from the home daily:

Your Age: under 2121-3031-4041-5051-60Over 60

Do you own or rent your home: OwnRent

What type of home do you live in: —Please choose an option—ApartmentCondoMobile HomeTwin HomeSingle Family Home

If you rent do you have written permission to have a cat: YesNoNot Applicable

If so, how many:

Does your apartment require cats to be declawed: YesNoNot Applicable

Are your current cats declawed: YesNoNot Applicable

Can we contact your landlord, if needed: YesNoNot Applicable

Landlord name:

Landlord phone number:

Number of people living in your home and ages:

Anyone have any allergies to cats: YesNoNot Sure

Are all family members in agreement to adopt a cat: YesNo

If you share your home with someone and unexpectedly split up, who would care for the cat:

How much do you think it costs to own a cat for a year:

Do you know the average life expectancy of a cat:

Are you prepared to care for the cat for the duration of its life: YesNoMaybe

Do you have any pets currently: YesNo

If so, list type and ages:

Are they current on vaccinations: YesNo

Are they spayed and or neutered: YesNo

What type of food do you feed them:

If you currently own any cats, where did you acquire them:

Have they been tested for feline leukemia: YesNoNot Sure

Where are your current cats kept: Not ApplicableIndoors onlyindoors/outdoorsalways outdoors

Where do you intend keep this cat: Not ApplicableIndoors onlyindoors/outdoorsalways outdoors

Have you ever had to re-home a pet: YesNo

If so why:

Have you adopted a pet before: YesNo

If so, from where:

How long do you think it will take for the new cat to adjust to your home and other
pets:

Do you have room in your home to temporarily separate the new cat until
acclimated: YesNo

If you have issues with a new cat in your home, are you willing to work on these
Issues: YesNoMaybe

What would make you give up a pet:

Are you willing to allow an Adopt-A-Pet representative do a home visit to see where the animal will live: YesNo

Would you allow us to contact your current veterinarian: YesNo

Name of Vet:

Address of Vet:

Phone of Vet:

If requested do you have references we could check: YesNo

Signature:

Date (YYYY-MM-DD ):

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