CARE Cat Adoption Application

General Information
Cat Adoption Application Form
Name of Applicant*

First NameLast Name
Age of Applicant*
Applicants must be at least 21 years old to adopt
Name of Co-Applicant

First NameLast Name
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 type of cat are you interested in adopting? Check all that apply.*

Kitten(s)AdultSeniorUndecided / no age preference
Are you interested in adopting a specific cat?*

Yes - I am applying for a cat I saw on PetfinderYes - I am applying for a cat I met at the shelter / in a foster homeYes - I am applying for a cat that I saw on FacebookNo - I am still considering all options
Which cat(s)/kitten(s) are you interested in adopting?*
List the name(s) of all cats you're interested in
Describe the type of personality and/or appearance you would like your cat to have:*
Ex: playful, friendly, lap cat, good with kids, good with other dogs, male, orange etc.
If the cat(s) you are interested are no longer available for adoption, would you like us to continue to process your application for pre-approval in the event that another cat 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
Are you looking to adopt now, or in the future? *
If future, please provide an estimate as to when you'll be ready to bring home your new cat
Home & Family
Describe your home*

Single-FamilyApartmentCondo/DuplexPublic HousingStudent Housing
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

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 cats been mostly indoor with some time spent outdoors? How often did they go out? Please explain:*
Do you plan to let your cat out for outdoor time? If so please explain.*
Did you declaw any of your past or current cats?*

YesNoN/A - this is my first pet
Do you plan on declawing your adopted cat?*

YesNoI don't know
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 cat be alone?*
How would you deal with behavioral issues such as excessive meowing, destructive behavior, inappropriate urination etc.?*
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?*

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

YesNo
If you have to leave town, urgently or planned, where would your cat stay or who would take care of it?*
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:
Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo
If you answered "Yes" please provide a detailed description:
Are you willing and able to care for your cat for the full duration of its life (15-20+ years)?*

YesNo
Veterinarian

Please list your current / previous / planned veterinarian(s) and their phone number(s). We will contact them to verify your current pets are up to date on shots,; this is a requirement for new pet adoptions. Please call their office(s) to authorize release of information to us. If you are planning to utilize another vet but are not currently a client, please note that information.
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 CCFAW/ Randy Zimmerman*

AgreeDisagree
I understand that CCFAW/ Randy Zimmerman has the right to deny any application for any reason*

AgreeDisagree
I understand that CCFAW/ Randy Zimmerman is not able to guarantee the health or temperament of any cat, as many cats 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 cat, I agree to contact CCFAW/ Randy Zimmerman 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 CCFAW / Randy Zimmerman in the event that my adopted cat is lost/missing*

AgreeDisagree
I attest that the cat I am adopting is for me, in my home, and NOT a gift for anyone*

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 CCFAW/ Randy Zimmerman to contact my references, veterinarian(s), and landlord to verify said statements.
Applicant Name*

First NameLast Name
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Should be Empty:

	Name	Type of Animal	Sex (M/F)	Age	Fixed? (Y/N)	Up-to-date on vaccines? (Y/N)
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

	Name	Type of Animal	Sex (M/F)	Age	Why don't you have them any longer?
Pet 1
Pet 2
Pet 3
Pet 4

General Information

Cat Adoption Application Form

Home & Family

Current & Past Pets

Veterinarian

Personal References

Terms & Conditions