Adoption Questionnaire

Cat/Kitten Pre-Adoption Application
Name of specific animal you're interested in (if any):
Home Environment:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
What is the best time to call you?
Are you at least 21 years of age?*

YesNo
Residence*

House, ownHouse, rentApartmentLive with parentsDorm or other on-campus housing
How long have you lived at at this residence?*
How many adults in household? *
How many children?*

List ages of children

	Age
1.
2.
3.
4.
5.

Is anyone in your home allergic to cats?*

YesNo

Please tell us about the animals you have now.

	Name	Species	Breed (Dog)	Male or Female?	Spayed or Neutered?	Age	Notes:
1.
2.
3.
4.
5.
6.

Are dogs up to date on rabies vaccine?

YesNoNot applicable
Are current cats declawed?

YesNoNot applicable
Animal Care:
Have you previously owned a cat/kitten?*

YesNo
If yes, how long did you have the cat(s)?
What became of the cat(s)? Please be specific.
How long has it been since you owned a cat?
Have you ever rehomed or relinquished a pet to a shelter or rescue?*

NoYes
If yes, please tell us about that experience.
Please list reasons why you would give up a cat/kitten*
Where will this cat live?*

Strictly IndoorsIndoor/OutdoorOutdoorsOther
Do you plan to declaw this cat?*

Front OnlyAll FourUnsureNo I will not declaw
Are you looking for a

Kitten 12 weeks to 6 monthsKitten 6 months to one yearCat 1 year or olderSenior cat 8 years or olderNo preference
Any other comments or preferences
Name of your veterinarian (s) Please list all vet clinics your current or most recently owned pets have been to:
Phone number of your veterinarian:

Area CodePhone Number
Phone number of your veterinarian:

Area CodePhone Number
Phone number of your veterinarian:

Area CodePhone Number
If your pet's vet records are under a different last name, please list here
Are you planning to visit an adoption event you saw advertised?

YesNo
If yes, on what date are you planning to attend?
The adult cats at our private shelter in Marengo, IL can be met by appointment. If you would like an appointment to meet adult cats what days and times of day are you available?
Where did you find out about ASAP?*
I have read the above form and agree to comply with the above as stated with the understanding my veterinarian references will be checked.*

YesNo
That's it! You've reached the end!
Should be Empty:

Cat/Kitten Pre-Adoption Application

Home Environment:

Animal Care:

That's it! You've reached the end!