Serenity Animal Hospital Cat Adoption Application
Date
*
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Month
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Day
Year
Date
Name of cat(s) that you're interested in meeting
Name
*
First Name
Last Name
Date of Birth- for person who is filling out adoption application
*
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Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Best time to call
*
I am interested in a:
*
Kitten
Cat
What type of home do you live in? (house, apartment, condo, townhome, etc.)
*
Landlords Name and number - if applicable, please let them know we may be calling.
Do you
*
rent
own
live with parents
Current Employment Information
*
Employed Full time
Employed Part time
Unemployed
Retired
Student
If employed, please list your employer, job title/line of work and length of time employed there
How many adults live in your home?
*
How many children live in your home?
*
Age of children in the home
*
Does anyone in the home have a known allergy to dogs or cats?
*
yes
no
Please describe your household
*
Active
Noisy
Quiet
Average
Current Veterinary Hospital Name & Number. Please call the ahead of time to let them know that it's ok to release information to Serenity Animal Hospital
*
Please list your current & past pets: name, breed, age,
*
Are your pet(s) current on ALL vaccinations? (including DHLPCA, Rabies, Bordetella, Fecal Testing, Heartworm Test, and Canine Influenza OR Feline Distemper & Feline Rabies)
yes
no
Are your pet(s) spayed or neutered?
yes
no
Are your pets given heartworm preventative year round?
*
yes
no
Are your pets given flea preventative year round?
*
yes
no
If you answered no to either of the last FOUR questions, please explain why
If you have every relinquished custody of a pet before, please explain why:
*
I would be willing to adopt a: (select all that apply)
*
Very high energy,active pet
cat that needs medication
cat that needs grooming
Mellow/easy going pet
shy cat
very affectionate/attention seeking pet
pet that needs little to no grooming
Where will your cat spend most of the day?
*
Number of hours (average) that the cat will be home alone?
*
Who will have primary responsibility for this pet's daily care?
*
Who will have financial responsibility for this pet?
*
What will happen to the pet if you go on vacation?
*
If you move in the future, what will you do with the pet you are planning to adopt?
*
Will you allow the cat on furniture/beds?
*
Will the cat have run of the house?
*
Are you aware that veterinary care could cost up to $600 per year, without any serious illness?
*
Do you agree to provide regular, yearly health care by a licensed Veterinarian?
*
Do you agree to keep this pet as an indoor cat?
*
Do you agree to contact Serenity if you can no longer keep this pet?
*
What will you do if the pet is destructive while left alone?
*
What would cause you to return your potential cat to us in the future? check all that apply
*
biting/nipping
medical needs
marking/can't be house broken
fighting with current pets
counter surfing/begging
chewing/destroying possessions
separation anxiety
divorce or death of spouse/partner
changed my mind about having a pet
kids leave home/won't be caring for pet
change in health
new baby
new partner doesn't like the pet
new job/moving
loss of income
NONE OF THE ABOVE
Personal References- please list the Name, Number & Relationship for 2 references
*
Have you ever owned a cat before?
*
What is your opinion on declawing cats?
*
Do you plan on declawing this cat?
*
Where will you keep the litter box? How many will you have?
*
What would you do if your cat didn't use the litter box?
*
All of the information I have given is true and complete. This pet will reside in my home as a pet. I will provide it with quality cat food, plenty of fresh water, indoor shelter, affection, annual physical examinations, vaccinations, heartworm and flea preventative from a licensed Veterinarian.
*
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