Cat's Name

Cat's Description and Sex

Your Name

Street Address

City, State, Zip

Phone Number

Cell Number

Email Address

Employer

Occupation

Employer Phone

Date of Birth

Name of Spouse/Partner

Number of Adults in your Home

Number of Children in your Home

Ages of the Children

Type of Dwelling

Do you own or rent?
Own Rent

Landlord's Name

Landlord's Phone

Are you at least 18 years of age?
Yes No

Do you have any other pets in the home?
Yes No

Please enter the names, ages, and breeds of other pets in the home below:

Veterinarian/Clinic Name

Veterinarian/Clinic Phone

Name(s) of Pets Taken There

Are all of your pets spayed or neutered?
Yes No

Have your cats been tested for FIV FeLV?
Yes No

Are all of your pets current on their shots?
Yes No

Are any of your cats declawed?
Yes No

Do you plan to declaw?
Yes No

If you plan to declaw, why?

Is this cat a gift?
Yes No

Do you agree to spay or neuter?
Yes No

Will the cat be an indoor or outdoor cat?

Is anyone in the household allergic to animals?
Yes No

Have you had pets in the past?
Yes No

Primary reason for adopting this pet:

Pet History

Please list any pets you have had in the past. Please include how the pet was
obtained, how long he/she was kept, and what happened to the pet:

Have you adopted a pet from an animal shelter/organization before?
Yes No

If so, when and where?

Have you ever surrendered a pet to an animal shelter/organization before?
Yes No

If yes, was it your own pet or a stray?

Name of organization where you surrendered the pet:

If something happened and you were unable to care for your animal, would there be someone to take care of it?
Yes No

Under what circumstances would you not keep this cat?

Animals are as individual as people. Are you willing to spend the time and effort to help this cat adjust to home/lifestyle?
Yes No

Would you permit an on-site premise check?
Yes No

Please enter the letters below: