First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Name of cat(s) interested in:
Choose an animal: Hazel Rose

Married*
Choose one: Yes No

Name of spouse, significant other or roommate(s) (please list all adult residents):*

Place of Employment:*

Are you or your spouse in the military?*
Choose one: Spouse Self Neither

EOS/PRD

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Mostly Inside Mostly Outside

What traits are you looking for in a pet

Is this animal a gift for someone?*
Choose one: Yes No

Who is the cat a gift for?*

Why are you interested in adopting a pet at this time*

How did you hear about us*

Do you own or rent your home*
Choose one: Rent Own

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

How long have you lived at your current address?*

If you rent, have you received the approval of your landlord to have an animal*
Choose one: Yes No NA

If you rent, please enter your landlord's name and phone number*

How many people reside in your household*

How many children*
Choose one: None 1 2 3 4 5 6 7 8 9 10

If children, what are their ages?*

• Have you or any member of your household ever experienced allergies or asthma?*

Do you have a balcony?*
Choose one: Yes No

Will the cat be allowed on the balcony*

Do you have a pet door?*
Choose one: Yes No

Where does the pet door go?*

Do you have unscreened windows?*
Choose one: Yes No

Will the cat be allowed access to the entire house or only part of the house? Which part? Why?*

Do you have coyotes in your neighborhood*
Choose one: Yes No

What predators do you have in your neighborhood?*

• Do you object to our organization doing a home check before placing the cat(s) with you?*
Choose one: Yes No

Have you ever had cats?*
Choose one: Yes No

How many cats do you have now?*
Choose one: None 1 2 3 4 5 6 7 8 9 10

If you have a cat(s), what are their ages?*

Where will the litter box be kept?*

Have you ever given up a pet? If yes, please explain*

How many dogs do you have now?*
Choose one: None 1 2 3 4 5 6 7 8 9 10

If you have a dog(s), what are their ages?*

What are the breeds of dogs you now have?*

Will the cats interact with the dogs?*
Choose one: Yes No

Do you keep identification on your pets at all times?*
Choose one: Yes No

Where will the animal sleep*

Have your pets had any serious illnesses? Describe.*

Veterinarian's Name and Phone Number*

For cats only: Are you planning to declaw either traditional or laser?*
Choose one: Yes No

If yes, why and what is your understanding of the surgical procedure?*

What will you do if future medical treatment for the cat is over $500?*

Are your other pets spayed / neutered?*
Choose one: Yes No

Are they up to date with vaccinations?*
Choose one: Yes No

What will you do with the cat when you go on vacation?*

What will you do if the cat becomes destructive in the house?*

What will you do with the cat if something happens to you where you will no longer be able to care for the cat?*

What will you do with the cat if you must move to a place that doesn’t allow pets?*

How much time will you be spending at home with your cat?*

Who will be responsible for the daily care and maintenance of your cat?*

Other?

Under what circumstances would you NOT keep the cat? SELECT ALL THAT APPLY

Have you applied with any other rescue*
Choose one: Yes No

I am aware that the potential commitment of time, patience and expense needed for a cat can span 20 years or more. I understand that cats need affection, attention and understanding and that they can get sick and require expensive medical treatment. I understand that I may need to adjust my lifestyle to accommodate my new pet. I am ready to make that commitment. Please enter your initials*

I certify that the information entered on this applicant is true. Enter your name and date*