Adoption Form

Name of Cat You are Applying for:*

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Okay to text to this number?*

YesNo

Best time to contact you:*

I currently live in:*

ApartmentHouseCondoTownhouse

I currently:*

OwnRent

If you rent, please provided your landlord's name and phone number. 19th Ward will contact your landlord to verify the pet policy for their property.

How long has you been at this address?*

How many adults live in your home?*

How many children live in your home?*

If there are children residing the home, what are their ages?

Is anyone in your home allergic to cats?*

YesNo

If yes, what is your plan to manage/treat these allergies?

What attracted you to the cat you are interested in?*

Do you plan on having this cat declawed?*

YesNo

Have you had pets in the past as an adult?*

YesNo

Have you ever had a pet euthanized for non medical reasons?*

YesNo

Have you ever rehomed or surrendered a pet to a shelter or rescue group?*

YesNo

Do you currently have pets?*

YesNo

If you do have pets, please list them by name and include species, breed, age and gender:

Are your current pets spayed/neutered?

YesNo

Are your current pets up to date on vaccines?

YesNoUnsure

If you answered "No", to either of the previous questions (your pet(s) are not spayed/neutered or not up to date on vaccines) please explain below:

If you have cat(s) did you have them declawed?

YesNo

Do your current pets get along with other animals?

YesNoUnsure

Do you currently have a regular veterinarian?*

YesNo

If yes, please provide, Account Holder's Name, Veterinarian name and phone number below. Upon completing this application, please call your vet office and give them permission to speak with 19th Ward Community Cats.

If you answered "NO" and you do not have a vet, please select one and call them to see if they are accepting new clients. We will need this information in order to approve your application.

Are you willing to allow a representative of 19th Ward Community Cats to conduct a home visit, if necessary?*

YesNo

Is there any other information you would like to add to your application?

Adopting a pet is a life-long commitment. We take the task of matching up pets with the right home and family very seriously and thoroughly review each application. Expect this process to usually take 2-3 days, if your vet office replies to us immediately. Please be patient, we are working with dedicated volunteer staff members who are doing their best to process your application in a timely manner.

By electronically signing and submitting this application, I certify that the above information is current, true and correct to the best of my knowledge. Additionally, I acknowledge that falsification of any information on this application can result in denying approval, or if an animal has already been adopted by me, the return of that animal to 19th Ward Community Cats.

Signature*

Today's Date:

Date

Adoption Application