Cat Adoption Form
Name of Applicant
*
First Name
Last Name
Date of Application
*
-
Month
-
Day
Year
Date
Name of Pet You Are Interested in:
*
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How long have you lived at the above address?
*
Are you 18 years or older (check one)?
*
Yes
No
Do you live with your parents (check one)?
*
Yes
No
What type of home (check one)?
*
House
Townhome
Farm
Apartment
Condo
Other
Do you (check one) :
*
Own
Rent
If you rent, please provide contact info for your landlord:
*
Does your rental/lease allow for pets (check one)?
*
Yes
No
N/A
Where will your pet live (check one)?
*
Inside
Outside
May we do a home inspection of the living arrangement for your pet?
*
Yes
No
Do you have pets at present?
*
Yes
No
If you said yes above, please list number and types of pets:
*
Where do your pets live (check one)?
*
Inside
Outside
Are your pets vaccinated?
*
Yes
No
Are your pets spayed/neutered?
*
Yes
No
If not fixed, why not?
*
Please provide the name of your veterinarian:
*
Provide veterinarian contact phone #
*
Please enter a valid phone number.
Format: (000) 000-0000.
Who will care for and train your new pet?
*
If something happens to you, what plans have you made for your pet’s care?
*
If you go on vacation, how will your pets be cared for while you are away?
*
What happens to your pet if you move?
*
Do you have a regular source of income?
*
Yes
No
How much are you willing/able to pay for medical costs for your pet annually?
*
How much are you willing/able to pay for medical costs for your pet in an emergency?
*
Have you ever lost a pet or had to turn one into a shelter/rescue?
*
List all the people, including ages, who live in your home:
*
Agree to requirements
*
I understand and agree to the requirements of CSHS and will abide by their final decision in this adoption process.
Signature:
*
Please verify that you are human
*
Submit
Should be Empty: