CARE Cat Adoption Application

Animal Adoption Application & Contract.
General Information

Please provide us all of the following information.
Name of Applicant*

First NameLast Name
Age of Applicant*
Applicants must be at least 21 years old to adopt
Email Address*
example@example.com
Cell Number*
Alternative Phone Number
Employment*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What animal are you interested in adopting?*

CatDogOther
Please enter the name or the animal or describe the type of personality and/or appearance you would like to have:*
Ex: playful, friendly, lap cat, good with kids, good with other dogs, male, orange etc.
If the animal you are interested is no longer available for adoption, would you like us to continue to process your application for pre-approval in the event that another animal interests you?*

YesNo
Who is this pet for?*

MyselfMy familyRelativeFriendOther
Are all members of the household aware of the adoption and in agreement?*

YesNo
Have you applied to adopt from us previously?*

YesNo
Have you adopted from us previously?*

YesNo
Home & Family
Describe your home*

ApartmentCondo/DuplexPublic HousingStudent HousingHouse
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:
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
Current & Past Pets
Do you have any pets currently?*

YesNo
If you currently have pets, please tell us about your pets. Leave blank if your previous answer was no.
Have you had any pets of your own in the past 10 years?*

YesNo - this is my first pet
Have you ever had a pet euthanized?*

YesNo
If yes, please explain the circumstances:
Have your current or past animal/animals been mostly indoor with some time spent outdoors? How often did they go out? Please explain:*
Do you plan to let your animal out for outdoor time? If so please explain.*
Did you declaw any of your past or current cats if applying for a cat?*

YesNoThis is my first petN/A
Do you plan on declawing your adopted cat if you are adopting a cat?*

YesNoI don't knowN/A
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 animal be alone?*
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?*

YesNoN/A
Are you willing to give your new pet time to adjust to its new environment? (Note: this could take anywhere from several days to several months)*

YesNo
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 pet for the full duration of its life?*

YesNo
Veterinarian

Please list your current / previous / planned veterinarian(s) and their phone number(s)
Vet Clinic*
Vet Clinic Phone*
Last name that the pet(s) are listed under (if applicable):*
Previous Vet Clinic
Previous Vet Clinic Phone
Personal References

Please provide 2 non-family references (eg. neighbors, coworkers, family friends etc.)
Reference 1*

First NameLast Name
Reference 1*
Relationship to Reference 1*
Ex. Neighbor, coworker, roommate, family friend
Reference 2*

First NameLast Name
Reference 2*
Relationship to Reference 2*
Ex. Neighbor, coworker, roommate, family friend
Terms & Conditions
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 from Little Bit Of Heaven Rescue*

AgreeDisagree
I understand that Little Bit Of Heaven Rescue has the right to deny any application for any reason*

AgreeDisagree
I understand that Little Bit Of Heaven Rescue is not able to guarantee the health or temperament of any animal, as many animals 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 animal, I agree to contact Little Bit Of Heaven Rescue by phone and/or email to discuss return/or need for help of the adopted animal*

AgreeDisagree
I understand that I am to immediately contact Little Bit Of Heaven Rescue in the event that my adopted animal is lost/missing*

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 Little Bit Of Heaven Rescue to contact my references, veterinarian(s), and landlord to verify said statements.
Applicant Name*

First NameLast Name
Signature*

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Animal Adoption Application & Contract.

General Information

Home & Family

Current & Past Pets

Veterinarian

Personal References

Terms & Conditions