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	Country

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 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.

Your name *