ASPCA Registration Form

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

My cat's name is*

Forever Name

My cat's name at KittyKind was*

KittyKind Name

My cat's age is*

Age

Describe the cat's coat color/markings*

Coat Color/Markings

My cat's gender is*

MaleFemale

The breed of my cat is*

DSH [Domestic Short Hair]DLH [Domestic Long Hair]Other

List all medications the cat is currently being given [if none, enter None]*

Medications

List any flea or tick treatments given in the last 30 days of which you are aware [if none, enter None]*

Flea/Tick Treatments

List any current medical conditions, including coughing, sneezing, vomiting or diarrhea, of which you are aware [if none, enter None]*

Medical Conditions

Have you taken your cat to get a rabies vaccination since adopting from KittyKind? If yes, bring documentation with you on the day of the appointment. If no, one will be given by the ASPCA as KittyKind is required by the Department of Health to have every cat vaccinated against rabies.*

YESNO

Have you taken your cat to get a microchip since adopting from KittyKind? If yes, enter the microchip number below. If no, fill out the Microchip Enrollment form on this site as the cat will be microchipped by the ASPCA.*

YESNO

If applicable, enter microchip number.

Additional services requested. Your adoption rep will let you know if these services should be requested.

FVRCP vaccineFeLV Test [$25 fee]Revolution [$10 fee]

I will drop off my cat*

between 6:15 - 6:30 AM @ Petco Union Square E. 17th & Broadwaybetween 7:15 - 7:30 AM @ ASPCA Glendale Clinic 70-25 83rd Street, Glendale, NY 11385

I will pick up my cat at*

6:00 PM @ Petco Union Square E. 17th & Broadway5:15 PM @ ASPCA Glendale Clinic 70-25 83rd Street, Glendale, NY 11385

With which KittyKind adoption rep did you work?*

What color is the FLAT TOP/BOTTOM HARD CARRIER you are using for transport?*

Please read the following ASPCA Clinic rules:

I will bring my cat(s) in a rectangular flat top/bottom hard carrier with one cat per carrier
My name and phone number are attached to the carrier in a visible location
Restrict cat's access to food after midnight on Friday; access to water is okay
Do not feed your cat Saturday morning prior to dropping off
If meeting at the Glendale location, I will not enter the ASPCA clinic

Rescue Group

I have read and will abide by the ASPCA Clinic rules listed above and understand that these veterinary services are provided by the ASPCA. KittyKind cannot be held responsible for complications resulting from surgery and services provided by the ASPCA*