CHCC Expression of Interest Form for Adoption

Dear applicant: Thank you for your interest in adopting! 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 25 years old to adopt. All cats available for adoption are fully vetted, which includes multiple complete veterinarian checkups, microchipping, spay/neuter, deworming, flea treatment, F3 vaccination and lifetime council registration.

Name of Applicant*

First NameLast Name

Age of Applicant*

Applicants must be at least 21 years old to adopt

Name of Co-Applicant

First NameLast Name

Email Address*

Best Contact Phone Number*

Area CodePhone Number

Alternative Phone Number

Area CodePhone Number

Occupation*

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Are you an Australian citizen or permanent Australian resident?

YesNo

Are you interested in adopting a specific cat?*

Yes - I am applying for a cat I met at the foster homeYes - I am applying for a cat that I saw on FacebookNo - I am still considering all options

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

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:

If you rent do you have written permission for cats in your lease or in an official letter from the Real Estate/Owner?

YesNo

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	Desexed? (Y/N)	Up-to-date on vaccines? (Y/N)
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

Have you had any pets previously 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:

Will you cat/kitten be

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:

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

YesNo

Vet Clinic*

Vet Clinic Phone Number*

Area CodePhone Number

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

Previous Vet Clinic

Previous Vet Clinic Phone No.

Area CodePhone Number

I certify that I am at least 21 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*

AgreeDisagree

I understand that you have the right to deny any application for any reason*

AgreeDisagree

I understand that you are not able to guarantee the 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 you to discuss return/or need for help of the adopted animal*

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

I hereby authorize you to contact my veterinarian(s), and landlord if necessary to verify said statements.

Signature of Applicant*

First NameLast Name

Date*

Date

Email

example@example.com

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Expression of Interest for Adoption Form

General Information

Home & Family

Current & Past Pets

Veterinarian

Terms & Conditions

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