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Cat/kitten you are interested in *:
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Name *:
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Spouse/roommate:
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Address *:
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City *:
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Zip:
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Home phone *:
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Email *:
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Occupation:
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Employer:
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Work phone:
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Spouse's occupation:
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Spouse's employer:
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Spouse's work phone:
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Do you live in a:
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House
Condo
Apartment
Mobile Home
Military
Other:
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How long have you lived there:
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If less than 2 years, give previous address:
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Do you rent:
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Yes
No
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If yes, do you have your landlord's permission to have cats?
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Yes
No
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May we contact your landlord?
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Yes
No
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Landlord's name
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Landlord's phone
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Contact date
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Name of vetenarian/hospital:
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Estimated annual cost for medical care:
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Would you object to an inspection of your residence?
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Yes
No
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Do you plan to put an ID Tag on this cat?
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Yes
No
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How many hours a day will this cat be left alone?
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Where will the cat be kept during this time?
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Will the cat be kept:
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Indoors
Outdoors
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Do you have a balcony?
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Yes
No
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Do you have screens on all your windows?
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Yes
No
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Where will you keep your litterbox?
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Is anyone in your household allergic to animals?
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Yes
No
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Is anyone in your household a regular user of tobacco products?
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Yes
No
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Have you owned a dog or cat before?
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Yes
No
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If yes, what happened to them? (If deceased, please state cause of death and how long ago):
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What other animals do you currently own?
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# of cats:
# of dogs:
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Give breed, sex, and ages of all pets:
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If cats, do they have their claws?
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Yes
No
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Have they been spayed/neutered?
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Yes
No
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When were they last vaccinated?
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List the names and ages of all children living at home:
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Where will the cat sleep? (please be specific)
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Who will be responsible for feeding, grooming, and training your new cat?
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Cats have been known to claw furniture, carpet and drapes, dig in potted plants, etc. How do you plan to deal with these potential problems?
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How soon after the cat arrives home will it be left alone?
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How often do you travel?
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How do you plan to provide for the cat when you are out of town?
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What will happen to the cat if you move locally?
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What will happen to the cat if you move out of state?
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What will happen to the cat if you move overseas?
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Under what conditions would you not keep this cat?
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Divorce
Move
New Baby
New Job
Illness
New Girlfriend/Boyfriend/Roommate
Other (please specify):
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Why do you want a cat? (Please number as many choices as apply, in order of importance: 1, 2, 3)
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For children
Companion
For Spouse
Mouser
As a Gift
For another pet
Other (please specify)
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Do you plan to declaw your cat?
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Yes
No
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If so, why?
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How did you learn about this cat?
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Union Tribune
Radio or TV
Other
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Are you a member of any animal welfare or rescue organizations or humane societies? If so, please list:
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Are you able and prepared to accept the financial obligations of caring for a cat should it become ill, including all necessary and veterinarian recommended medical care?
Yes
No
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I CERTIFY THAT THE ABOVE IS TRUE, AND THAT ANY FALSE INFORMATION MAY RESULT IN NULLIFYING THE ADOPTION.
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