First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Work Phone x
Cell Phone
Date
Name of pet(s) you are interested in
An adopter must be 21 yrs or older to adopt a cat/kitten from EAPL. Do you meet this requirement?
Name of EAPL Representative working with you, if applicable
How did you hear about EAPL?
How long have you been at your current address
House Type: (check one)
Own Or Rent
Landlord Name
Landlord Number
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List all pets owned (past & current in last 10 years)
List NAME, SPECIES, BREED, AGE, SPAYED/NEUTERED STATUS, AND PETS' CURRENT STATUS
PET 1
PET 2
PET 3
PET 4
PET 5
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Who do you use for veterinary care?
How do you feel about declawing?
Why do you want this animal?
If other, please describe
How many adults are in your family or house?
How many children are in the home?
Ages of children
Has everyone in the family agreed on adding a new pet to the family?
Who will be responsible for feeding and litterbox training?
Is anyone in the family/house allergic to animals?
Is anyone home during the day?
If so, who?
How many hours will the pet be home alone on average during the day?
Where will it be when you are away?
Where will the pet be when you are home?
Where will the pet sleep?
Who will care for the pet if you are away for a few days?
If something unexpected happens to you or your living situation do you have a contingency plan in place for your pet(s)?
How will you deal with the following behaviors if the pet exhibits them once he/she is in your home:
Biting
Incompatibility with other pets
Illness in Pet
Do you know the local ordinances in the county in which you live?
Adoption Fee For Adult Cats – $75
Adoption Fee For Kittens – $85 (includes microchip)
Admin Use Only
EAPL Representative Comments: