First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

Animal you are applying for*
Choose an animal: Audrina Aurora Brody Frosty Frosty Girlfriend Jonah Not Listed Oatmeal Phoenix Pixie Polar Bear Pre-adoption Precious Pete Rae Rainbow Sally Shadow Sheeran Wolf Ziggy

What is your age?*

Please provide 3 character references and phone numbers (non-family members) and please let them know we may be contacting them.: *

Please provide the name and phone number of your current and/or previous veterinarian or clinic to contact for a reference (please call you veterinarian and let them know we will be calling): *

Are all members of your household in agreement with this adoption?

Does anyone in your home have allergies to animals or have asthma? *
Choose one: Yes No Not sure

Who will be the pet's primary caregiver? *

Have you adopted from an animal welfare group before?*
Choose one: Yes No

If yes, what group?

Please list all people living in your household, including yourself and any children. List everyone's names and ages.*

List any pets you own or have owned in the past five years, their species, and their ages. If this is your first pet, please note below.*

How many of these pets are spayed/neutered? Where are these animals now?*

If you have cats, have they been tested for Feline Leukemia and Feline Immunodeficiency Virus (FIV) If so, what were the results?*

Have you ever given up a pet? If yes, what were the circumstances?*

Do you live in a*
Choose one: House Condo Mobile home Apartment Other

Do you own or rent?*
Choose one: Rent Own

If rent, provide name and phone number of landlord to obtain permission for this animal to live in your home:

Are you willing to have a representative from Kizzy's Place come to see where the pet will be living*
Choose one: Yes No

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*

Are you aware that a new environment is stressful for your new pet, and they may exhibit uncharacteristic behavior?*
Choose one: Yes No

If you have other pets in the home it is best to provide your new cat with a separate space to settle in for a few days before introducing them to your other pets. Are you able to do this?*
Choose one: Yes No

Where will your new pet stay when nobody is home? *

Where will your new pet sleep at night?*

How many hours each day will your new pet be home alone? *

What length of time will you allow your new pet to adjust to their new home? *

Are you willing to work through your new pet's issues, if any? *
Choose one: Yes No

Will you keep the cat inside only? *
Choose one: Yes No

If you move, will you take the cat with you? *
Choose one: Yes No Not sure

How will you handle if your new cat begins scratching furniture or carpet (ex. Punish, spray bottle, nail caps, declaw, buy scratch posts etc):*

Do you understand that a cat can be an 20+ year commitment, and can cost a significant amount of money to care for? *
Choose one: Yes No

What circumstances would lead you to give up your new cat? *

If you had to give up your cat, what would you do with him/her?*

How did you find out about Kizzy's Place?