Cat Adoption Application

Today's Date

Date

Applicant Name

First NameLast Name

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County

How long at this address?

Occupation:

Place of employment:

Co Applicant or Back up Caregiver Name:

First NameLast Name

Relationship to Applicant:

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County

How long at this address?

Occupation:

Place of employment:

How long:

How many adults are there in your family (their relationship to you)?

How many children (ages)?

Is anyone living in the home allergic to cats?

What type of home do you live in?

Please describe your household.

How much do you think routine vet care costs yearly?

What is your reason for adopting?

Is there a cat currently in the home or visiting the home that is positive for HIV or leukemia or has an upper respiratory infection?

If yes, date.

What other pet(s) do you own and/or have living with you (specify type, breed, sex, weight, temperament, name, age)?

Are these pets up to date on vaccines?

Are these pets spayed/neutered?

If not, why?

Have you ever surrendered a pet or rehomed a pet?

If so, why and when?

Have you ever had a pet euthanized?

If so, why and when?

Have you ever declawed a cat you owned?

If so, why and when?

Have you ever lost a pet to an accident?

When, please explain.

Veterinarian's Name

First NameLast Name

Clinic Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Desired age:

Desired sex:

Desired color:

Where will this cat live?

Where will your cat spend the day?

Where will your cat spend the night?

Who will have primary responsibility for this pet's daily care?

Who will have financial responsibility for this pet?

Do you agree to provide regular health care by a Licensed Veterinarian?

Do you agree to have your cat Microchipped?

Do you agree to a follow up phone call regarding the adoption/pet?

Do you agree to keep your cat as an indoor pet?

I AGREE TO CONTACT SSDD IF I CAN NO LONGER KEEP THIS CAT OR CARE FOR ITS HEALTH NEEDS. (SSDD will help you help your cat)

Please initial

I AGREE THAT THIS PET MAY ONLY BE REHOMED WITH FAMILY, A FRIEND, NEIGHBOR OR CO-WORKER, SOMEONE I TRUST ONLY. (SSDD must be notified of this)

Please initial

I AGREE TO NEVER DE CLAW THIS CAT.

Please initial

I AGREE NOT TO USE OR PUT ON NAIL CAPS OR SOFT PAWS ON THE CAT I'M ADOPTING.

Please initial

Are you willing to let a representative of SSDD visit your home by appointment?

How much are you prepared to pay for emergency vet care?

Are you prepared to care for this cat for up to 15 years?

1. Name

First NameLast Name

Relationship (neighbor):

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

2. Name

First NameLast Name

Relationship (neighbor):

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

I own my home?

Landlord/Property Manager Name:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Rules Governing pets:

Providing SSDD with this information means you are allowing a SSDD Representative to call your vet, property owner, and references during the application and follow-up process. Please understand our goal is to make sure these animals are placed in good homes. The responsibility of SSDD is the best interest of the animals. SSDD has the right to refuse an adoption for any reason. The application remains the property of SSDD.

I certify that the above information in this application is true and accurate to the best of my knowledge. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that SSDD reserves the right to annul the adoption and reclaim the animal.

By signing below, I agree that the animal listed above is being adopted by me as a pet for myself and/or my immediate family. If at a later date I am unable to care for this animal, I agree to contact the "current owner" described above and give them the option to reclaim this animal at no charge. I agree to care for this animal humanely and responsibly. I will provide himi/her with clean and adequate shelter, food, water, and veterinary care. This animal will reside inside my home and will not be allowed to wander freely outside.

Applicant Signature

Date

Co Applicant Signature

Date

Cat Adoption Application

Family & Housing

Veterinarian

About the Cat You Wish to Adopt

Personal References

Landlord/Property Manager: