Part One-General Information
Name: Spouse:
Address: Suite/Apt:
City: State: Zipcode:
Home Phone: Email:
Do you Work? Full Time
Part-Time		 Students Only: Full-Time
Part-Time
Graduate
Undergraduate
Occupation School/College

Part Two—Your Living Situation
Do you: Rent
Own House
Apartment
Other:
How many people live with you? Adults Children
How old are your children?
Does any member of the household have asthma or allergies to pets? Yes No
Do you have your landlord's/condo's permission to own a cat? Yes No N/A
Would your cat go with you if you moved? Yes No
If your family changed (marriage, divorce, new baby) would you keep the cat? Yes No

Part Three—Pets Past, Present, and Future
State law requires adequate housing, shelter, feeding, and veterinary care. Will you abide by
State and local animal control laws? Yes No
Do you plan to take your pet to a veterinary for preventative and medical care? Yes No
Are you aware that shots and routine veterinarian care typically cost $100 or more a year? Yes No
Do you have or have you ever had a pet? Yes No
How many?
Ages of Pet(s)
Breed(s)
Are they spayed/neutered? Yes No
Are their vaccinations current? Yes No
Have you ever given a pet away? Yes No
If YES, please explain:
Have you had a pet die from a contagious disease or unknown cause in the last three months? Yes No
If YES, please explain:
Who is your veterinarian?
Reason(s) for adopting: Barn Cat/Mouser
Child's Pet
Family Pet
Gift
Companion for Pet
Companion for Self
Other:
Are you interested in a kitten, teen, adult, or any particular one you have seen on the web site?
Are you committed to keeping and caring for your pet during its entire lifetime? Yes No
My cat will live: inside/outside
inside exclusively
outside
Do you plan to declaw? Yes No
Have you or anyone in your household been charged and/or convicted of any form of animal cruelty? Yes No

Verification
I certify that the above information is true and correct. Also, I realize that adopting a pet is a lifetime commitment.
How did you hear about our organization? Newspaper
Television
Radio
Website
Friend
PetsMart
Sign
Other:
All fields are required