Name Phone #

E-mail Address

How long have you lived at this address?

What is your living status? Rent Own

If renting, you must provide a copy of your lease or your landlord's contact information. We maintain the right to contact him/her before any adoption can occur.

Landlord's Name Phone #

1. Name of cat(s) you're interested in adopting (if known):

2. Why are you looking for a cat? Companionship Mouser Family Pet Barn Cat

3. What other animals do you have?
    Dogs # Sterilized # Breeds
    Cats # Sterilized #
    Small animals # Types

4. Where will the kitten/cat be allowed? Inside Only Outside Only Inside and Outside

5. Who will be the primary caretaker? Myself Spouse Children Ages

6. Are you aware of any family allergies? Yes No

7. One reason cats enter shelters is because of allergies. If a family member should develop an allergy, what is your plan?
   

8. Would you be open to a visitation after adoption? Yes No

9. Would you like to stay in contact, regarding this kitten/cat? Yes No

10. Do you presently have a veterinarian? Yes No
    If yes, do we have permission to contact him/her for a 'release of information'? Yes No
    If no, would you allow use to recommend one for you? Yes No

11. Please provide your veterinarian's contact information:
     Name of Clinic/Vet Phone
     How long have you had this veterinarian?

12. What will you do if, at a later date, you have to move?

13. What do you think your total yearly costs will be to care for this kitten/cat (food, toys, litter, vet costs, etc...)?

14. What food are you planning on giving your adopted kitten/cat?

15. Will you consider de-clawing this kitten/cat? Yes No
     If yes, are you aware of what this involves and the potential consequences? Yes No

16. In the case of an emergency, who will care for this kitten/cat?
     Name Relationship

Please provide two (2) references that are NOT family related; previous/current employer, landlord, educator, business owner, etc...

1. Name Contact # Relationship

2. Name Contact # Relationship