Form
Potter’s Angels Rescue Cat Adoption Application
Name
*
First Name
Last Name
Age
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Cat/Kitten are you interested in
*
Spouse/Partner name
*
Other adults 18+ in house, name and age
*
Children living in home, name and age
*
Employer
Home
*
Rent
Own
Live with parents/family
Back
Next
Please list 4 references below, no more than 2 can be a relative.
Personal Reference #1 Name and phone or email and relation to you
*
Reference #2 Name and phone or email and relation to you
*
Personal reference #3 Name and phone or email and relation to you
*
Personal Reference #4 Name and phone or email and relation to you
*
Current Veterinarian, name and phone number
*
Type of Dwelling
*
Single Family House
Duplex
Single Wide Trailer
Apartment
Condo/Townhouse
Landlord name (if you live with parents, then they are your landlord. If no landlord state n/a
*
Landlord phone number or email. If no landlord state n/a
*
Anyone in household with allergies to animals?
*
Have you ever had to rehome a pet? If yes, please explain
*
Please list any pets currently living in your home along with breed, age, gender and how long you have had them
*
Please provide any additional info that may be helpful
How did you hear about Potter’s Angels Rescue?
I certify that the information provided is correct. I understand that proper food and veterinary care can be costly and I am financially and physically able to care for the cat.
*
I agree
By checking this box, I understand that home checks might be made if there are concerns following adoption. If PAR finds information contained in this application to be false, we retain the right to turn down my application or remove cat from my premises without a refund of monies paid.
*
I agree
By checking this box, I agree to allow a PAR representative to contact my landlord, town clerk, veterinarian, and personal references in order to verify that information I have provided is entirely correct.
*
I agree
By checking this box, I am indicating that this is a valid and legal substitution for my written signature on this legal document titled Potter’s Angels Rescue Cat Adoption Application.
*
I agree
WE CANNOT HOLD CATS FOR YOU. THIS TAKES UP VALUABLE FOSTER SPACE NEEDED TO SAVE LIVES. PLEASE DO NOT FILL OUT THIS APPLICATION UNLESS YOU ARE READY AND PREPARED TO ADOPT AT THE TIME OF SUBMISSION. THANK YOU FOR CHOOSING TO ADOPT.
*
I understand cats can not be held before adopting
I am serious, ready and prepared to adopt at this time
*
I agree
I am 21 or older
*
I agree
Submit
Should be Empty: