Cat Adoption 2018
Cat name:
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Date
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Adopter's First Name
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Adopter's Last Name
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Email Address
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Street Address
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City
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State
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Zip Code
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Contact Number
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Occupation/Employer
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Weekly Hours Worked
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How Long at Current Job
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Do ALL adults in your household agree to this adoption?
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No
Yes
Names and Ages of Household Members
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Do you have other pets?
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No
Yes
Describe your other pets, including name, age, sex, and whether they are neutered/spayed
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Have you ever owned any animal other than the one listed above?
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No
Yes
If Yes, what kind of animal and when?
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What happened to the animal?
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What is the name and phone number of your current veterinarian?
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A personal reference is required. Please list the name and relationship of a reference we may contact. Please let them know we will be calling.
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Reference Phone number
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Reference email
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How long have you resided in your current location?
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Do you own or rent your residence?
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Own
Rent
Live with parent/guardian
Live with roommates or significant other
What kind of type of residence do you live in?
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House
Apartment/Condo
Townhome
Mobile Home
If renting, are animals allowed on premise?
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No
Yes
If renting, please list name of landlord and phone number
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If you are moving soon, what will happen to your pet?
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Please select one of the following:
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I have had animals my whole life (experienced owner)
I have worked with animals my whole life and am actively looking for the perfect companion (ready to own)
I have loved animals but never owned (novice)
I am looking to adopt for the following reason(s):
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Companion/Family pet
Assistant/Therapy pet
Companion for another pet
Gift
Other
Will the adopted cat live primarily inside or outside?
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Inside
Outside
Combination
Have you ever applied or adopted from another group?
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No
Yes
If yes, what organization or person did you work with in the last 5 years?
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Have you ever been declined for adoption ?
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No
Yes
If yes, what was the reason?
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Have you ever given up or turned in an animal to a rescue or shelter? If so, why?
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What is your general philosophy on vet care?
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Spare no expense
Within budget constraints
Pet insurance
If treatment or care is very expensive, I may need assistance or return the cat.
Will you have the cat declawed?
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No
Yes
Which of the following worst case scenario, would you consider giving up your pet?
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Death of owner/loved one
Divorce or separation
Large vet expense
Loss of bladder control
Cat nips or scratches at stranger or family members
Out of state move or new residence where pets are not allowed
Dog and current pets/family member incompatible Allergies to pet (self or family member) Chronic Illness New baby or plans to have a baby Dog is not what I thought it would be Barking/neighbors complaining Would never give up Other
If you cannot keep your cat, you must return him/her to Shelter2Rescue Coalition. Do you agree?
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No
Yes
Shelter2Rescue Coalition and the representatives of the rescue reserve the right to call and verify care of the adopted pet with the veterinarian?
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No
Yes
I hereby agree to hold Shelter2Rescue Coalition, Inc and it's representatives harmless against any and all claims, damages, cost, expenses, or other items pertaining to cat that is being adopted, or anything resulting from or caused by the adopted cat.
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No
Yes
Signed Name and Date
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Clear