Cat Adoption Application

Serenity Animal Hospital Cat Adoption Application
Date *

Month Day Year
Date
Name of cat(s) that you're interested in meeting
Name *

First Name Last Name
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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Serenity Animal Hospital Cat Adoption Application