Cat Adoption Application
Adopters must be 18 years or older
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Place of Employment
*
Driver's License / State ID Number: (please be prepared to show ID)
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Type of Housing:
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Single Family Home
Apartment
Townhome
Dorm
Farm
Mobile Home
Other
Do you rent or own your home?
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Rent
Own
Other
How long have you lived at your current address?
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Which pet(s) are you interested in adopting from us?
Who is your current veterinary clinic or which clinics have you used in the past?
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If not BAH, which veterinary clinic(s) may we call for a veterinary reference on your current or previous pets?
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Why are you choosing to adopt from us?
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How did you hear about us?
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Facebook
Friend / Relative
Current Client of BAH
Other
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Adoption Informtion
What is your past and/or current experience with cats?
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First time owner
Have had one or two cats as an adult
Had a cat as a child
Do you have any experience in resolving behavior issues? (Explain)
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Have you adopted with us before?
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Yes
No
If yes, where is the pet now?
Who will care for this cat primarily?
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What are some reasons you would relinquish this cat back to us?
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Previous and Current Pet Information
Have you ever had a pet: (select all that apply)
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Run away
Get hit by a car
Die in your care
Kept as an outdoor pet
If so, please explain:
Have you ever surrendered a pet to a private rescue or individual?
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Yes
No
If yes, please explain the circumstance:
Please list all pets you currently have. Include their species (canine, feline, etc.), breed, age, gender (M/F), if they are altered (spayed/neutered), how long you have had them, and where they primarily reside (inside/outside/both).
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Are your current animals up to date on vaccines?
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Yes
No
Please list all pets you've had in the past. Include their species (canine, feline, etc.), breed, age, gender (M/F), if they were altered (spayed/neutered), and why they are no longer in your care.
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Are you prepared for veterinary care expenses?
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Yes
No
Who is your primary veterinarian?
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Would your pet's records be under another name other than the one provided on this application? If so, please provide name.
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Do you have other veterinarians that may have records for any current or previous pets? If so, please provide their name and contact information.
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Household Information
Please describe your household:
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Active
Noisy
Quiet
Average
Busy
Other
Please list the names and ages of ALL people living in the home and their relationship to you. (Failure to fully disclose this information will result in immediate adoption denial)
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Do children (other than immediate family) ever visit your home? If so, how often? Age(s) of the children?
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Does anyone in the household have an allergy to any kind of animal? If yes, have they consulted with their doctor about getting an animal? If yes, are they taking any medication?
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Has anyone in your household ever been convicted of animal cruelty, neglect, or abandonment?
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References
Please provide 3 references that we can contact, and a phone number to contact them at.
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New Pet Information
Please understand that it may take a new cat 2 weeks or more to adjust to a new home and/or to other pets and visitors.
Where will you keep this cat? (Check all that apply)
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Free run of house
Crate in house
Inside Cat
Outside Cat
Inside/Outside Cat
In Garage
Yard with a fence
Basement
Other
Where will the cat be kept during the day? At night?
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Why do you want a cat? (Check all that apply)
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Mouser/Barn Cat
Breeding
Companionship
Children
Travel Companion
Gift for Friend or Relative
Other
Do you plan on declawing the cat? If so, why?
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It is unrealistic to expect a child of any age to assume complete responsibility for an animal. Ultimately the adult(s) of the household are responsible for the complete care of the animals in the home. Are you prepared to take all responsibility for this animal should your child/ren become disinterested?
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Yes
No
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Please give careful consideration to adopting this animal. Animals are not toys or a short-term commitment, they do require daily attention. Make sure your lifestyle allows the time, emotional commitment, and financial responsibility this animal will need over its lifespan.
It is the responsibility of Bennington Animal Hospital to place this animal in an environment compatible with its needs and to ensure the adoption is in the best interest of both the animal and the applicant. Bennington Animal Hospital reserves the right to deny any applicant.
Please initial that you have read and agree to the following statements. The prospective caregiver agrees:
Cats are to live *INDOORS* in a private residence as companion animals.
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To provide the cat with sufficient quantities of nutritious food and fresh water each day.
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Never to strike or otherwise harm the cat.
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Spaying or neutering is required by six months of age. If the cat is not spayed or neutered prior to adoption, proof of surgery must be mailed to the original caregiver within 30 days of the procedure.
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To ensure that the cat's vaccinations for rabies and distemper are current and to provide veterinary care upon sickness, disease, or injury.
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To give the original caregiver visitation rights to ensure that the terms of this adoption agreement are being observed.
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If the cat must be relinquished for any reason by the prospective caregiver, s/he MUST NOT turn the cat over to a humane society, shelter, or person, but must return the cat to the Adoptee (Bennington Animal Hospital). If the phone number and/or address for the original caregiver is no longer operative, the caregiver will make a good faith effort to locate and contact the original caregiver.
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I understand that failure to perform the foregoing agreement will constitute a breach of contract. In the event of any such breach of contract, I authorize the original caregiver to reclaim possession of the adopted cat.
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**Bennington Animal Hospital may follow up by phone or in person on any adoption to ensure compliance with the adoption contract.**
I certify that I have read the above information and that all information I have given is true and accurate and is subject to verification by Bennington Animal Hospital. I understand that any falsification may result in the nullification of an adoption.
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Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: