TNR SWVA Application for Adoption
ABOUT YOU
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Driver's License Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
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ABOUT YOUR HOME
Do you rent or own your home?
*
Please Select
Rent
Own
If you rent, please provide the following information.
Name
Landlord's First Name
Landlord's Last Name
Phone
Landlord's Phone Number
Format: (000) 000-0000.
Email
Landlord's Email Address
How long have you lived at your current address?
*
Years
Months
Do you have plans to move in the future?
*
Yes
No
Have you ever owned a cat?
*
Yes
No
Which cat are you interested in adopting?
*
Why do you want to adopt a cat?
*
Family Pet
Companion for Current Pet
Mouser
Other
If other, please explain.
List all members of your household including names, ages and relationships:
*
Are all members of your household in agreement about adopting a cat?
*
Yes
No
Is anyone in your home allergic to cats?
*
Yes
No
Where will the cat stay when you are not at home?
*
How many hours a day will your cat be left alone?
*
Where will the cat sleep at night?
*
Do you plan to let the cat outside?
*
Yes
No
If yes, please tell us about the outdoor environment and safety measures provided.
Who will be responsible for feeding, cleaning litter boxes, taking the cat to & from vet appointments, etc?
*
Are you prepared for the financial responsibility of caring for a cat including food, litter, yearly veterinary care and other supplies?
*
Yes
No
I have some concerns
What will you do if the cat develops behavioral issues such as scratching furniture or using the bathroom outside the litter box?
*
What arrangements will you make for the cat’s care if you go on vacation or in the event of an emergency?
*
What arrangements will you make for the cat in the event of your passing?
*
If you can no longer care for the cat properly, do you agree to contact TNR SWVA & return the cat to our organization?
*
Yes
No
Are you willing to allow a TNR SWVA volunteer to visit your home?
*
Yes
No
Do you currently have pets?
*
Yes
No
Please list any pets owned in the last 3 years and where they are now. Please include name, species, breed or mix, age and spay/neuter status.
*
Have you ever had to surrender or rehome a pet?
*
Yes
No
If so, what were the circumstances?
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EMPLOYER
If you are currently employed, please provide the following information.
Are you employed?
*
Yes
No
Retired
Occupation
Company Name
Name
Supervisor's First Name
Supervisor's Last Name
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
May we contact your employer?
Yes
No
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VET REFERENCE
Do you have a current or previous veterinarian? If so, please provide the following information. If not, please provide the veterinary clinic that you will be using for your adopted cat.
*
Yes
No
Veterinary Clinic
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Veterinarian's First Name
Veterinarian's Last Name
PERSONAL REFERENCES
Please provide the name, relationship, telephone number & email address for three references who can speak for your ability to care for animals (other than your veterinarian).
Reference #1
Name
*
First Name
Last Name
Relationship
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Reference #2
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Reference #3
Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Is there anything else that you would like to share with us today?
By signing below and submitting this form, I certify that the above information is true and correct. I understand that false information may result in nullifying this adoption. TNR SWVA reserves the right to contact veterinary and personal references listed above and to deny adoption. One of our volunteers will be in touch with you soon!
*
Please verify that you are human
*
Submit
Submit
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