Application for Feline Adoption

Application for Feline Adoption
Please check out our adoptable pets page here:
Kaleidoscope Health Rescue Inc
Name

First NameLast Name
Date:

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Cat Desired From Petfinder Page:*
Home Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Email Address: *
example@example.com
DOB:
Are you currently employed?

YesNoOther, please explain
Employer’s name and contact:
Number of people in the household:
Please list ages of children if applicable:
Are you or any member of your family allergic to cats?

YesNo
Co-Applicant Information
Name:
Relationship:
Home Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Are you currently employed?

YesNoOther, please explain
General Information
Type of Residence:
Do you rent or own?

RentOwn
If rental, are cats allowed?
Complex name, if applicable:
Manager/Landlord Name:
Manager/Landlord Phone Number:
Please enter a valid phone number.
Where will cat live?
Where will cat live?
Please enter a valid phone number.
The cat will be:

indoor onlyoutdoor onlyindoor/outdoor
How many hours per day will the cat be left alone?
Where will the cat stay when alone?
In the absence of the primary caregiver, who will care for the cat?
Under what circumstances would you return the cat to us?
Are you willing to take responsibility if the cat acquires an illness?

YesNo
Are you willing and able to pay the veterinary costs of caring for your new pet?

YesNo
How do you consider your pets

Just a petPart of the family
How much time are you willing to spend to allow your new pet to adjust to your home?
Pet Information
Have you had pets in the past five years?( If yes, please fill out the following.)

YesNo
Please list any previous and current pet names, age, species, and any veterinary history for each pet.
Please list the name of your current veterinary practice and doctors name.
Current Veterinary Practice Phone Number:
Please enter a valid phone number.
Please contact your current/past Veterinary clinic and give them
permission to disclose information about your pet(s) records with us.
Are you aware that a cat is a large and lifelong commitment?

YesNo
Owners Obligation
I, will abide by the following procedures and treatments placed on the adoption of the pet. They are as follows:
1. To continue with any vaccines that the cat may need to protect from harmful diseases at Dickin Memorial Animal Hospital for the first year.
2. To have the cat spayed or neutered by the age of 6 months at Dickin Memorial Animal Hospital.
3. If any problems arise, and I cannot keep this pet, I will contact Dickin Memorial Animal Hospital and return the pet to them.
4. The information on this application is true and filled out to the best of my ability.
Applicant Signature:

Clear
Date:

MonthDayYear
Date
Should be Empty:

Application for Feline Adoption

Co-Applicant Information

General Information

Pet Information

Owners Obligation