First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

Age

I'm interested in adopting: (if more than 3, please indicate in comment section) *
Choose one: One cat/kitten Two cats/kittens Three cats/kittens Undecided

What is the name of the cat/kitten you are interested in adopting? (If not listed, please list the name in the following question).
Choose an animal: JS Litter Bandit JS Litter Smokey Luna

What is the name of any additional cat/kitten you are interested in adopting?
Choose an animal: JS Litter Bandit JS Litter Smokey Luna

Name of kitten(s) if it is not listed.

Occupation*

Place of Employment/Work Schedule*

Do you have a spouse/partner/roommate? **
Choose one: Yes No

If YES, please provide name, phone#, email, occupation, employer and work schedule for Spouse/Partner/Roommate.*

List all of the residents of the household (include ages of children)*

Has/have your household member(s) been around cats?*
Choose one: Yes No

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

Type of dwelilng*
Choose one: House Condo Apartment Other

Do you own/rent/share room? **
Choose one: own home rent home share room other

If rent/share room, do you have a signed pet addendum?
Choose one: Yes No

Landlord's name, phone# and email

Have you personally owned a cat?*
Choose one: Yes No

If YES, please provide info on your former cat(s) including what happened to the cat(s).

Have you ever relinquished an animal to a shelter, rescue, or another individual? Please describe. *

Were your previous your cat(s):*
Choose one: No Previous Pets Indoor Only Outdoor Only Indoor/Outdoor

Have any of the cats that you have owned or currently own been declawed?*
Choose one: Yes No

If yes, why?

Please list all pets currently residing in your home. Include name, species, breed, gender, age, spayed/neutered, personality, where kept, and length of time you've owned the pet.*

Are your current cat(s):*
Choose one: No Current Cats Indoor only Outdoor only Indoor/Outdoor

Are all your current pets up-to-date on vaccinations?
Choose one: Yes No

What is your primary reason for adopting? *

Who will be responsible for the care of the kitten(s)/cat(s)?*

Your newly adopted kitten(s)/cat(s) will be: *
Choose one: Indoor Only Outdoor Only Indoor/Outdoor Undecided

Please provide the name/phone number/address of your current Veterinarian/Clinic*

Does your home have (check all applicable)

If/when you travel, how do you intend to provide for the cat while you are away*

What factors could cause you to give up the newly adopted kitten/cat? *

What will you do if you can no longer keep the newly adopted kitten/cat? *

Anything else you'd like to share?

How did you hear about us?*