Application to Adopt

Cats/Kittens of Interests Cats/Kittens of Interests Chance Lila Nigella Peirce Stella Tahji

First Name

Last Name

Driver's License #

Email Address

Address 1

Address 2

City

State

Zip Code

Length of Time at Address

Employer

How Long with Employer?

Why do you want to adopt this cat/kitten?

How many adults live in your home?

Are there children, if so, how many and what are their ages?

Please list the name, type and age of any other pets in your home

How many animals have you owned in the past 5 years and where are they now?

In case of emergency, work travel, vacation, etc., who will care for this cat/kitten?

What would you do with your cat/kitten if you had to move into a place that would not allow pets?

An adult cat can live 15 years, thinking that far ahead, what circumstance would have to occur for you to surrender your cat?

A common feline behavior problem is urinating outside of the litter box. When a cat stops using its litter box, it is most frequently because the cat has a urinary tract infection. Please note in the list below or to the right, all the steps you would take to correct the situation.

I/we would . . . I/we would . . . Visit the vet Purchase medication for UTI Purchase medication to correct behavior Try different food or litter Evaluate household changes Crate/isolate to retrain litter habits Move litter box to suit cat None, I would return the cat

Have you ever given away a pet/cat? Have you ever given away a pet/cat? Yes No

If YES to the previous question, please explain why.

Please select one of the following: -- Please select one of the following: --HomeownerRent a homeRent an apartmentLive in a condoLive in a mobile homeLive with family/friend

If you do not own your home, please provide the name of the landlord, leasing company, condo association, or family/friend and their phone #

WE CANNOT PROCEED WITH THE ADOPTION PROCESS UNTIL THE LANDLORD, LEASING COMPANY, CONDO ASSOCIATION OR FAMILY/FRIEND IS CONTACTED.

How often do your pets visit the vet?

Please list your veterinarian's name, the clinic name and phone #, as well as the name your account can be found under

Please list 3 personal references (including name, phone # and relationship to you)

Do we have your permission to contact your vet and references? Do we have your permission to contact your vet and references? Yes No

Would you object to a home visit by a representative from our organization? Would you object to a home visit by a representative from our organization? Yes No

Are you willing to learn more about why we DO NOT declaw our cats? Are you willing to learn more about why we DO NOT declaw our cats? Yes No

Do you intend to allow this cat outdoors? Do you intend to allow this cat outdoors? Yes No Maybe

Please provide any additional detail that you would like for us to know when evaluating your application.

By signing below, you are indicating you have answered all questions truthfully and are aware that any false answers will be grounds for immediate rejection. You also give us permission to contact all personal references and your veterinarian, giving them permission to speak with us. I understand the statements I have read about this cat are true, based upon the foster evaluation of the cat. I understand the cat might behave differently (positively or negatively) in my home. I understand that while the cat might be good with the current foster's dogs, cats, children, etc., it may not be with my animal(s) or children. I understand that the cat may be housebroken in the home of the foster, but may relapse in my home. I understand the cat is represented to me as it performs in the foster home and any statements made regarding this cat are conditional to that foster home setting. I have read all of the information about this cat. I understand that I cannot claim I did not understand the facts about this cat, as understood by AnewEmergence. I understand that the statements made regarding this cat are simply overviews and are not guaranteed. Furthermore, I understand that my adoption fee is non-refundable for any reason.

Submitting this application serves as your digital signature Submitting this application serves as your digital signature I agree to the above and certify that it is accurate and complete, to the best of my knowledge.