Adoption Questionnaire

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Cell or Home Number*
Email*
Are you 18+ years old?*
- Yes
- No
Which best describes your lifestyle?*
- quiet/relaxed
- very active/on the go
- noisy/young children
- travel/work long hours
Are you*
- employed
- stay-at-home/retired
- student
Company/School name
Do you*
- Own
- Rent
Do all the adults and the home owner know you plan to adopt?*
- Yes
- No
Ages and names of children
Anyone have allergies?*
- Yes
- No
- Unsure
Name and phone number of your current (or most recent) veterinarian*
If you have animals now, please tell us about them
Name, age, gender, "fixed", vaccinated, cat/dog/etc.
What happened to your previous pets?
Do you want help introducing a new cat to your current animal(s)?*
- Yes
- No
- Undecided
Will you declaw this cat?*
- Yes
- No
- Undecided
Will you let this cat outside?*
- Yes
- No
- Undecided
Are you familiar with nail clipping?*
- Yes
- No
What will you do if the cat claws furniture or shows other destructive behavior?*
What are your plans if you should suddenly be unable to care for this cat?*
Name, relationship and phone number of Reference 1*
Please do not list other household members. (Examples of references are: neighbor, employer, co-worker, friend, etc.)
Name, relationship and phone number of Reference 2*
Why do you want to adopt a cat?*
- Family pet
- Companionship
- Mouser
Are you a previous adopter?
- Yes
- No
If yes, from where & when?
How did you hear about us?
- Google/web search
- Petfinder
- Adopt-a-pet
- Facebook
- PetSmart
- PetValu
- The Healthy Animal
- Flyer/handout
- Word-of-mouth
Would you like to be added to our e-mail list?
- Yes
- No
Name of cat or kitten of interest and/or name of foster person, if known:
Initials*
By initialing below, you certify that you understand the following:
1. The information contained within this form is accurate and not misleading in any way.
2. It is the agency/individual's right to refuse adoption to anyone and to contact individuals on this form.
Today's Date*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.