Adoption Application form

Which cat(s) are you interested in adopting? *
Full Name *

First Name Last Name
Co Applicant Full Name

First Name Last Name
Are you over age 18? *

Yes No
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number : *

Area Code Phone Number
Do you live in a: *
How long have you lived here? *
Do you: *

Own Rent Live with Parents Other
Please indicate landlord contact information *
Is someone home all day ?

Yes No
Where will the cat be kept when no one is home?
Are there children at home? *

Yes No
What are the ages? *
Is anyone in the household allergic to cats? *

Yes No
Is shedding a problem? *

Yes No
Is scratching a problem? *

Yes No
Would you object to a home visit as part of the adoption process? *
Please list all the pets you currently have: *
Have they been spayed or neutered? *

Yes No
What is the reason for not been spayed or neutered?
Do your pets go outside? *

Yes No
Are they on a leash? *

Yes No
Have your cats been tested for FeLV/FIV? *

Yes No Not Applicable
What were the results? *
Are your cats declawed? *

Yes No
List all the pets you have had in the recent past and what happened to each.
List any pets you adopted from CatNIP before (names, dates, ages).
Have you ever surrendered a pet? *

Yes No
What was the reason? *
Have you ever lost a pet? *

Yes No
Was it ever found? *

Yes No
Is this new pet to be a: *

House pet Child's pet Mouser Gift Other
Where will this pet be kept during the day? *

Inside Outside
Where will this pet be kept at night? *

Inside Outside
Have you ever been in violation of any animal laws? *

Yes No
Please explain *
Are you prepared to meet the expenses required to maintain this pet? (Remember: veterinary care can be costly) *

Yes No
Employer:
Job Title:
Name of your Veterinarian: *
Phone Number of your Veterinarian:

Area Code Phone Number
Please list two personal references (no relatives) with names and phone numbers.
Reference #1: Full Name *

First Name Last Name
Relation to applicant(s):
Phone Number

Area Code Phone Number
Reference #2: Full Name *

First Name Last Name
Relation to applicant(s):
Phone Number

Area Code Phone Number
By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I certify that the above information is correct, and I understand that the information will be verified.

Please allow several days for processing.
Date

Month Day Year
By clicking the check box and by typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
I agree with the terms
Your name *
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