Adoption Application
Please answer questions thoroughly and honestly so that we can help guide you toward choosing a cat that is a match to your lifestyle. All applicants must be 18 years or older to adopt from To The Moon and Back Cats, Inc. False or missing information will be cause for rejection.
Name of the cat(s) you are applying for.
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Type "undecided" if not sure yet.
Today's Date
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Month
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Day
Year
Date
What is your age? (You will be required to show ID to verify)
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What is your Birthdate?
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Month
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Day
Year
Date
To The Moon and Back Cats, Inc. processes adoptions between 1:00pm and 4:00pm. Please select a date and time that would be convenient for your adoption appointment. Please call if these times or dates do not work with your schedule and we can schedule a time that meets your needs. (717) 640-1166.
Contact Information
Your Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Would you like to add a 2nd adult adopter to this application?
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Yes
No
2nd Adopter's Name (if applicable)
First Name
Last Name
2nd Adopter's Phone Number
Please enter a valid phone number.
2nd Adopter's Email
example@example.com
Physical Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your Physical Address the same as your Mailing Address?
Yes
No
Mailing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
About The Adopter
Are you:
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a student
employed (work outside the home)
employed (work at home)
unemployed
homemaker
Other
How did you first learn about the cat you are interested in and/or To The Moon and Back Cats, Inc.?
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A friend/family
Facebook
Instagram
Nextdoor
Adopt-a-Pet
Website
Petfinder
Drove by and noticed sign & visited
Other
Have you owned or lived with a cat before?
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Yes
No
What is your reason for wanting to adopt a cat? (Check all that apply)
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Companion for myself
Companion for Child or Family Member
My pet died recently
For a friend
Companion for another pet
Emotional support/service animal
For a Barn/Rodent control
Change in living situation that allows pets now
Other
What are you looking for? (Check all that apply)
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Single cat
2 or more cats
Kitten(s)
Young Cat (10 months - 2 years)
Adult Cat (2 - 8 Years)
Senior Cat (Age 8+)
Barn/Rodent control cat
House Cat (Indoor Only)
Indoor-Outdoor Cat
Outdoor Only Cat
Other
Preferences? (Check all that apply)
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Long-haired
Short-haired
Hypoallergenic
Quiet
Chatty
Shy
Outgoing/Dominant
Relaxed/Mellow
Energetic/Playful
Independent
Seeks Attention
Good with other cats
Good with dogs
Good with children
De-clawed
Likes laps/being held
Specific Breed (specify breed in "other")
Other
Housing
Do you live in a
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House
Apartment
Studio
Condo/Duplex
Mobile/Manufactured home
Rural/Farm
Student Housing
Other
Do you have a (check all that apply)
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Fenced Yard
Unfenced Yard
Screened Windows
Cat/Doggie Door
Enclosed/Screened Patio
Catio (outdoor cat enclosure)
Balcony/Deck
Other
The traffic on my street is:
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Heavy
Moderate
Light
Other
Have any pets been hit by cars at this address?
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Yes
No
Other
In regards to your living space, please check one:
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I own my home
I rent my home
I live in a friend/family member's house
Other
If you are renting, are you permitted to have a cat on the property?:
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Yes
No
N/A
Other
May we contact your landlord to confirm that pets are allowed?
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Yes
No
N/A
Other
Landlord Name
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Landlord Phone
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Landlord Email
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Would you consent to a home visit of your residence by a To The Moon and Back Cats, Inc. representative prior to adoption (may not be necessary in every situation)?
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Yes
No
If no, please explain why you would not consent to a home visit.
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Have you ever needed to rehome a pet?
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Yes
No
If yes, please explain the circumstances which caused you to need to rehome your pet.
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If you are a student, explain your plans for your cat at the end of the school year, and describe how living conditions might change for your cat.
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Home Environment
How many pets do you currently have living in your home?
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Tell us about your other pets:
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(example: Pet 1. Male Dog, Dalmation, age 13, likes cats, energetic)
How many adults reside in your home?
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How many children under 18 reside in your home?
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List the ages of children in your home:
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Do your children have experience with cats?
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Yes
no
Other
Choose which options most often describe your home:
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Quiet
Busy/Noisy
People away most of the day.
People home most of the time.
Which family member will be the primary caregiver?
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Is everyone in your household aware and comfortable with a cat entering the home?
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Yes
No
Other
If no, please explain.
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Is anyone living in your home allergic to cats?
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Yes
No
Other
If yes, please explain how the allergy will be managed:
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Care of Your New Cat
Domestic cats can live up to 20 years - or even more! Are you willing to accept the responsibility of providing all basic necessities - food, water, shelter, attention, love, security, playtime, and medical care - for this cat's ENTIRE life?
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Yes
No
Unsure
If no or unsure that you are unable to care for the cat's entire life, please explain:
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It can cost between $500 - $2,500 a year to care for a cat, sometimes more, depending on your cat's needs. Are you able to afford this cat's care?
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Yes
No
Unsure
If no or unsure that you are able to afford the cat's care, please explain:
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How long, on average, will your cat be alone during the day?
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If you are on vacation, or away from home for more than 12 hours, who will care for your cat?
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Family/Friend/Neighbor
Pet Sitter
Boarding/Kennels
Cat will be self sufficient
Other
Will your cat be:
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Indoors only
Outdoors only
Indoor/outdoor
In a barn
Other
Where will your cat be kept during the day? (ex: Garage, barn, bedroom, outdoors, free roam inside, free roam outside, etc)
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Where will your cat be kept at night? (ex: Garage, bedroom, outdoors, barn, free roam inside, free roam outside, etc)
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All cats shed hair to some extent. How much shedding is acceptable?
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Light
Moderate
Doesn't Matter
Are you considering declawing this cat?
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Yes
No
Unsure
If yes or unsure, please explain your reasons.
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Are you willing to brush your cat often to prevent hairballs, mats, and to bond with your cat?
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Yes
No
Maybe
Other
Check all aspects of cat care that you are NOT comfortable with:
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Litterbox scooping
Claw trimming
Medicating
Petting/Brushing
Holding
Vet Visits
I'm comfortable with all.
It can take a cat weeks to months to fully adapt to your home, family, and other pets. Adjustment behavior might include: vocalization (especially at night), door dashing, hiding, scratching, undereating, overeating, conflicts with pets, etc.) Are you willing and able to provide the necessary time, patience, and understanding to help your cat through this time?
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Yes
No
Other
Do you have a "safe room" away from activity, children, and other pets that a cat can adjust in?
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Yes
No
Other
Which behaviors would be unacceptable and cause for you to rehome the cat?
Scratching furniture
Eliminating outside of the litterbox
Excessive Meowing
Biting
Scratching
Walking on counters
Fighting with other pets
Too much/too little energy
Other
In the event that you become incapacitated (ex: inability, illness, injury, death), please explain your plan to care for this cat.
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Do you have a current veterinarian? Please write their name and location.
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Thank you for applying.
Your Adoption Application will be reviewed by a To The Moon and Back Cats, Inc. staff member. To The Moon and Back Cats, Inc. reserves the right to deny this application per our discretion. Proof of identification is required at the time of adoption. This application becomes part of our Adoption Contract.
Please agree to the following statements and sign. Any statement not checked will be cause for denial of application.
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I agree to respond to a post adoption follow-up call or email from To The Moon and Back Cats, Inc. Staff.
I agree to provide my cat(s) with basic needs - food, water, space, shelter, litterbox or elimination area, attention, playtime, veterinary care, and a fear-free environment.
I agree to return my cat(s) to To The Moon and Back Cats, Inc. if I become unable to provide for basic needs.
I agree to return my cat(s) to To The Moon and Back Cats, Inc. before choosing euthanasia or abandonment.
I certify that all of the above information is true, and understand that any false information given will result in nullifying this adoption.
Signature
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