Adoption Application

Name as it appears on your Driver's License*

First NameLast Name

Name of Pet you wish to Adopt

Please provide your Facebook name and/or Instagram name*

Address*

Street Address, including apartment # if you have one.

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Please provide your birthdate*

Please provide ALL parties in the household and birthdate. *

Do you own or rent your home? *

If you rent, please provide you landlord's name & phone

Please provide a picture of your mortgage statement or deed, if you own your home. If you rent, please provide your lease.*

Please list current pets, newest of vaccines date and Felv/Fiv testing date.

Are your other animals good with cats?

Will your cat be indoor or outdoor?*

Will you be declawing?*

Please provide your veterinarian's name and phone number. Please include any past veterinarian or shot clinic you have used. Please call the veterinary office to allow a vet check to be completed as records can not be released with permission. *

If you have a medical emergency and your cat requires surgery, please explain to us how you will be taking care of that situation. Remember your animals, are a lifetime commitment. *

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?

If you go on vacation or leave town, who would care or your pet? *

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

If you answered "YES" please provide a detailed description.

Signature of Potential Pet Parent

By providing your initials, you are agreeing to have your adopted pet neutered by 5 month/4 pounds , & spayed 6 months/5.5 pounds. Your initials will also, serve right to BJR to regain the animal you adopted if proof of spay/neuter is not provided to the rescue.

Baby Jack's Rescue, Inc. Adoption Form