Adoption Application form

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

Full Name*

First NameLast Name

Co Applicant Full Name

First NameLast Name

Are you over age 18?*

YesNo

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number :*

Area CodePhone Number

Do you live in a:*

How long have you lived here?*

Do you:*

OwnRentLive with ParentsOther

Please indicate landlord contact information*

Is someone home all day ?

YesNo

Where will the cat be kept when no one is home?

Are there children at home?*

YesNo

What are the ages?*

Is anyone in the household allergic to cats?*

YesNo

Is shedding a problem?*

YesNo

Is scratching a problem?*

YesNo

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?*

YesNo

What is the reason for not been spayed or neutered?

Do your pets go outside?*

YesNo

Are they on a leash?*

YesNo

Have your cats been tested for FeLV/FIV?*

YesNoNot Applicable

What were the results?*

Are your cats declawed?*

YesNo

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?*

YesNo

What was the reason?*

Have you ever lost a pet?*

YesNo

Was it ever found?*

YesNo

Is this new pet to be a:*

Where will this pet be kept during the day?*

InsideOutside

Where will this pet be kept at night?*

InsideOutside

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

YesNo

Please explain *

Are you prepared to meet the expenses required to maintain this pet? (Remember: veterinary care can be costly)*

YesNo

Employer:

Job Title:

Name of your Veterinarian:*

Phone Number of your Veterinarian:

Area CodePhone Number

Please list two personal references (no relatives) with names and phone numbers.

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):

Phone Number

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

Phone Number

Area CodePhone 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

MonthDayYear

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*