EarthMother Rescue Cat Adoption Application

Dear applicant: Thank you for your interest in adopting from us! We are a foster based, 501C3 (applied)animal rescue servicing Cleveland County and surrounding areas. We focus our efforts on stray and abandoned animals that would not make it in a traditional shelter, but will take in any animal requiring assistance as long as fosters are available. Our mission is to place all of our animals in loving, permanent homes. You are not purchasing a pet from us; you are adopting a living, breathing, creature that deserves safety, love and care. Your answers to this questionnaire are assurance to us that the cats we care for are going to good, permanent homes. All of the information on this application is confidential. We do not use a first-come, first-serve process when adopting out cats. Instead, we focus on best fit for each individual cat. The process is intended to ensure a long-term successful adoption for both the family and pet. Cats can live for 15-20 years, so please make sure your lifestyle allows the time, patience, and ability to cover expenses your new pet will need over the years. Will you be travelling frequently, moving soon, or having children? Responsible pet ownership includes as-needed and routine veterinary care, quality food, preventatives, and other supplies. You must be at least 21 years old to adopt. All of the cats and kittens available for adoption are fully vetted, which includes a complete veterinarian checkup, FeLV testing, spay/neuter, deworming, Advantage II flea treatment, distemper and rabies vaccines. At times, these cats may require dental work, or other health related attention, which which we also take care of, prior to adoption. The adoption fee is $175 for kittens under 1 year, $125 for adult cats 1-6 years old and $100 for senior cats 7+ years old.

Name of Applicant*

First NameLast Name

Age of Applicant*

Applicants must be at least 18 years old to adopt

Name of Co-Applicant

First NameLast Name

Email Address*

Cell Number*

Area CodePhone Number

Alternative Phone Number

Area CodePhone Number

Employment*

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

What type of cat are you interested in adopting? Check all that apply.*

Kitten(s)AdultSeniorUndecided / no age preference

NOTE: Due to the fluctuating availability of kittens and the high-volume of kitten applications we receive, all kitten applications are placed on a waiting list until a kitten(s) that matches their application becomes available for adoption. Once this happens, the ECCO Applications Team will reach out to you to confirm whether or not you're still looking to adopt before processing your application. As a note, the wait time can take anywhere from a couple days to a couple of months. The reason for this is because kittens need to be in foster homes until they have reached a certain level of socialization and development (based on their age and weight). This wait time is applicable for all kittens, whether they're feral, orphaned, or born in foster care.

Are you interested in adopting a specific cat?*

Yes - I am applying for a cat I met at an event / in a foster homeYes - I am applying for a cat that I saw on FacebookNo - I am still considering all optionsYes - I am applying for a cat I saw on Adopt-a-pet.com

Which cat(s)/kitten(s) are you interested in adopting?*

List the name(s) of all cats you're interested in

Describe the type of personality and/or appearance you would like your cat to have:*

Ex: playful, friendly, lap cat, good with kids, good with other dogs, male, orange etc.

If the cat(s) you are interested are no longer available for adoption, would you like us to continue to process your application for pre-approval in the event that another cat interests you?*

YesNo

Who is this pet for?*

Are all members of the household aware of the adoption and in agreement?*

YesNo

Have you applied to adopt from EarthMother Rescue previously?*

YesNo

Have you adopted from EarthMother Rescue previously?*

YesNo

Are you looking to adopt now, or in the future? *

If future, please provide an estimate as to when you'll be ready to bring home your new cat

Describe your home*

Do you own or rent your home?*

OwnRentI live with a parent, guardian or family member

If you rent or live in a family member's home, please provide their contact information here:

Who else lives in the home or visits regularly? Please list names and ages for individuals under 18 years of age.*

Ex: Michael, husband (41); Jessica, daughter (7). Susan, mother-in-law (80).

Is your home busy or quiet?*

BusyQuietA mix of both, depending on the time & day

Are any members of the household allergic to pets (eg. dogs, cats etc.)*

YesNo

If you had to move, are you willing to find housing that accepts pets?*

YesNoMaybe

Do you have any pets currently?*

YesNo

List all current household pets:

	Name	Type of Animal	Sex (M/F)	Age	Fixed? (Y/N)	Up-to-date on vaccines? (Y/N)
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

Have you had any pets of your own in the past 10 years?*

YesNo - this is my first pet

List all previous pets that you no longer have (within last 10 years):

	Name	Type of Animal	Sex (M/F)	Age	Why don't you have them any longer?
Pet 1
Pet 2
Pet 3
Pet 4

Have you ever had a pet euthanized?*

YesNo

If yes, please explain the circumstances:

Have your current or past cats been mostly indoor with some time spent outdoors? How often did they go out? Please explain:*

You understand EarthMother Rescue does not condone outdoor cat roaming or living situations with the exception of barn cats. If you plan to let your cat out for outdoor time will it be harnessed with you supervising or do you have an outdoor catio? If so please explain.*

Did you declaw any of your past or current cats?*

YesNoN/A - this is my first pet

Are you willing/able to take your pets to yearly check-ups?*

YesNo

If your pet becomes ill, are you able to afford a veterinary bill?*

YesNo

How many hours per day would the cat be alone?*

How would you deal with behavioral issues such as excessive meowing, destructive behavior, inappropriate urination etc.?*

Does your home have space (i.e. a spare bedroom, office, or bathroom) to separate new pets from current pets during the acclimation and introduction period?*

YesNo

Are you willing to give your cat/kitten time to adjust to its new environment? (Note: this could take anywhere from several days to several months)*

YesNo

If you have to leave town, urgently or planned, where would your cat stay or who would take care of it?*

If you were no longer able to care for your pet, or had to move, what would happen to your pet?*

Have you ever had to re-home a pet or surrender it to an animal shelter, animal control etc.?*

YesNo

If you answered "Yes" to the above question, please explain the circumstances:

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

Are you willing and able to care for your cat for the full duration of its life (15-20+ years)?*

YesNo

Vet Clinic*

Area CodePhone Number

Last name that the pet(s) are listed under (if applicable):*

Previous Vet Clinic

Area CodePhone Number

Reference 1*

First NameLast Name

Reference 1*

Area CodePhone Number

Relationship to Reference 1*

Ex. Neighbor, coworker, roommate, family friend

Reference 2*

First NameLast Name

Reference 2*

Area CodePhone Number

Relationship to Reference 2*

Ex. Neighbor, coworker, roommate, family friend

I certify that I am at least 18 years of age*

AgreeDisagree

The information I have provided on this application is true. I also recognize that any misrepresentation or omissions may result in the loss of privilege to adopt from EarthMother*

AgreeDisagree

I understand that ECCO has the right to deny any application for any reason*

Disagree

I understand that EarthMother is not able to guarantee the future health or temperament of any cat, as many cats come in with unknown histories. There are traits that could change upon adoptions and I take responsibility to care for and address these issues if they do arise*

AgreeDisagree

I understand that anything could happen in life, and if I find that I am no longer able to care for my adopted cat, I agree to contact EarthMother by phone and/or email to discuss return/or need for help of the adopted animal*

AgreeDisagree

I understand that I am to immediately contact EarthMother in the event that my adopted cat is lost/missing*

AgreeDisagree

I attest that the cat I am adopting is for me, in my home, and NOT a gift for anyone*

AgreeDisagree

I understand that I am responsible for paying for all follow-up vaccines, wellness visits & medical procedures my pet will require in the future.*

AgreeDisagree

If I am adopting a kitten that is too young to be fixed (foster-to-adopt), I understand that I am to keep it separate from my other cats until it is fixed & FeLV tested.*

AgreeDisagreeN/A - I don't have any cats currentlyN/A - the cat I am applying to adopt has already been FeLV tested

I hereby authorize EarthMother Rescue and Outreach to contact my references, veterinarian(s), and landlord to verify said statements.

Signature of Applicant*

First NameLast Name

Date*

Date

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Cat Adoption Application

General Information

Home & Family

Current & Past Pets

Veterinarian

Personal References

Terms & Conditions