First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Cell Phone*

Date of Birth*

Name(s) of the cat(s) you are interested in*

Why do you want to adopt this cat*

List family pets, along with how long you owned the pet, and where the pet is now. If you don't have pets, write "no pets"*

If you currently have pets, are they spayed and/or neutered?

Are your pets up to date on their vaccinations and monthly flea preventatives

Please provide the name and phone number for your current veterinarian. If you don't have one, please provide the information for the veterinarian you plan to use.*

Do you have a contingency plan to pay for unexpected emergency vet bills? Please describe.*

If you have a cat is she/he permitted to go outside unleashed?*
Choose one: Yes No I don't have a cat

Are you planning on declawing your cat (if not already declawed)*
Choose one: Yes No

What precautions will you take to introduce your cat into your home if you have other animals? Write "N/A" if you don't have animals*

Do you own or rent?

If you rent, does your landlord allow pets?*
Choose one: Yes, my landlord allows pets My landlord does not allow pets I own my home or cohabitate with home owners

If you rent, please provide your landlord's name and phone number. If you own or cohabitate, please enter 'N/A"*

Does your landlord know you are looking for a new pet?*
Choose one: My landlord is aware that I am actively looing to adopt a cat I have not yet informed my landlord of my desire to have a pet I own my home and do not need approval from a landlord

Are all the members of your household in agreement about adopting a cat?*
Choose one: Yes No I haven't told them yet

Please list the members of your household. Name/Relation/Birthdate*

Does anyone in the household have pet allergies?*
Choose one: Yes No

How many hours will the cat be left alone and where will he or she be kept?*

On a scale of 0-10, please rate the typical noise level in your home (0 would be a single person living alone without a barking dog who has infrequent guests, and 10 is a home with multiple children, pets, and/or guests creating an environment filled with noise most of the time) *

What precautions will you take to assure that your cat remains indoors at all times?*

Have you ever had to give up a pet? If so, why and where did the pet go? If this doesn't apply, please write "N/A"*

What circumstances would force you to give up this pet?*

Have you been involved in a domestic disturbance in which the police were called? If so, explain.*

Do you agree to permit a visit to your home by appointment?*
Choose one: Yes No

Do you and the adult members of the household consent to a criminal background check as a part of the screening process?*
Choose one: Yes No