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Adoption Questionnaire
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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.