Adoption Form

Battle for Empathy Adoption Survey

To apply to adopt, please complete all questions.
Name*

First NameLast Name
E-mail
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Which pet are you interested in adopting?*
Please list the ages and names of ALL people living in your household and their relationship to you.*
Do you have a reliable income to be able to financially support your new pet and meet their veterinary needs?*

YesNoI don't know.
Please list the name(s) of your current employer:*
What is your residential status?*

I own my own home.I rent with a pet policy.I live with the home owner.I do not have a permanent residence.Other
If you rent, are you aware of a pet deposit and/or additional rent that may be required by your landlord? If yes, how much is your pet deposit?*
Landlord's name and phone number:*
Please tell us about your current and previous pets.*
Are all of your current pets spayed/neutered?*

YesNoN/A
If you have dogs, are they on heartworm prevention? If so, what kind?*
Have your pets had vaccines within the past year? If no, how long ago were they vaccinated?*
Why do you want to adopt?*
Describe your optimal pet (including preferred age)*
Where will you keep your pet after adoption?*

Indoor OnlyBoth indoors and outdoorsOutdoors onlyI don't know.
Please list the veterinary hospitals you currently use or have used in the past. Please include their phone numbers if possible.*
Does anyone in your home suffer from pet dander allergies? If yes, what treatments are/will be used to relieve these allergies?*
Have you ever owned a cat in the past for which you were the primary caretaker?*
Have you ever sold, given away, surrendered or put down a pet? Please elaborate on why and what happened to the pet.*
Have you ever had a cat declawed?*
How many hours per day will your cat be home alone?*
What do you (will you) do with your pets if you need to be away from home overnight or if you plan a vacation?*
If you move, are you prepared to search for a place that will accept your pets?*
Would you like to provide a personal reference? Please provide name, phone number and relationship to you. *
If for any reason you are no longer able to care for your pet(s), who will be next in line to care for them? *
May we visit your home prior to the application approval?*
Are you prepared for the commitment of caring for your pet for the next 10+ years? *
If you have any social media profiles, please list the links to all your profiles below:*
Is there anything you would like to add?
Signature*

The information I have provided in this application is true and correct. I understand that completion of an adoption agreement and payment of an adoption fee are requirements of an adoption. I understand that any misrepresentation of facts in this application, failure to sign and return the adoption contract, failure to pay the adoption fee, or failure to comply with any requirement of Battle for Empathy, Inc, will result in removal of the adopted animal and I agree to immediately surrender physical custody of the animal in that circumstance. My signature indicates my agreement and understanding of the above statement.
Signature Date

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Battle for Empathy Adoption Survey