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1
Cat / Kitten's name
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2
Full Name
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First Name
Last Name
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3
Phone number and email where we can reach you
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4
Are you 21years of age or older?
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Yes
No
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5
Birth Date
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Month
Day
Year
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6
Are you currently employed if yes, please provide name and phone number and or spouse work information?:
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7
Do you rent or own?
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Own
Rent
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8
Provide current address and new address if planning to move withing the next 6 months ?:
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9
If rents, what is your landlord's policy on pets?:
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10
Please provide landlord's name and phone number
*
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11
Provide the name of all the people leaving in the house, include name, age, and relationship to adopter
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12
How long have you lived at current address?
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13
Are you planning on moving within the next 6 months?
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Yes
No
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14
If yes, what are your plans for your pets if you move?
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15
What is your reason for wanting to adopt a cat?
*
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House pet
Mouse Patrol
Companion
Companion for pet
Gift
Other
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16
If other, please explain:
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17
If adopting a kitten, where would the kitten be kept when alone?
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18
Are you planning on declawing your new cat or kitten?
*
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Yes
No
Maybe
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19
Are your current cats declawed?
*
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Yes
No
N/A
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20
Are any members of your household allergic to animals or have asthma?
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Yes
No
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21
If yes, please describe:
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22
Over the past 5 years, how many pets have you owned? (Include current pets)
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0
1
2
3
4
5
6+
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Please Select
0
1
2
3
4
5
6+
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23
Please list name, breed, age, and if they're still living with you? (if not, why?)
Please be very specific.
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24
Have you ever re-homed any of your pets? how long ago, reason to re-home:
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25
If you currently own a dog or cat, how does he/she react to new cats?
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26
Are your present pets up-to-date on their annual vaccines?
*
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Yes
No
N/A
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27
If no, please explain:
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28
Are your present pets spayed or neutered?
*
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Yes
No
N/A
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29
If no, please explain.
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30
Were your previous pets spayed or neutered?
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Yes
No
N/A
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31
If no, please explain.
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32
Can/Will you provide your cat with monthly flea/tick prevention?
*
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Yes
No
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33
Please provide your Veterinarian name, address and phone number.
*
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34
If your cat displays behavioral problems (such as poor litter box habits, inappropriate scratching etc.) how would you go about correcting the behavior?
*
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Contact a Professional
Use a book
Personal Knowledge
Other
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35
If other, please explain:
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36
What type of solution would you be willing to try if housebreaking accidents continue after the first week (check all that apply)?
*
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Move box to new location
Try a different litter
Clean box more often
Have cat examined by vet
Use a cat door
Return Cat
None
Other
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37
If other, please explain:
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38
Where will your cat spend most of his/her time?
*
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Please Select
Indoors Only
Outdoors Only
Indoors and Outdoors
Barn Cat
Basement/Garage
Confined
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Please Select
Indoors Only
Outdoors Only
Indoors and Outdoors
Barn Cat
Basement/Garage
Confined
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39
Are you prepared to commit to a pet for 15 - 20 years (average life span)?
*
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Yes
No
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40
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