Mary's Kitty Korner, Inc. Pre-Adoption Inquiry Form

Mary's Kitty Korner, Inc. Pre-Adoption Inquiry Form

24 Ellerton St. Chicopee, MA 01020 ~ Phone: 860-379-4141 ~ Fax: 860-770-6236 Website: www.maryskittykorner.org ~ E-Mail: marys.kitty.korner@sbcglobal.net
Mary’s Kitty Korner, Inc. is a small group of people helping displaced cats find new loving homes. We want every applicant to understand the responsibilities involved in caring for a pet. It is a life time commitment and many cats live 16 to 20 + years. Cats bond with their human family and need to be treated as a member of the family. Please proceed with this application if you are willing to make that commitment.
- All applicants must be 23 years or older and be able to provide a picture ID once accepted.
- Please understand that the application process can take a few days, so cats will not be going home with you the same day. Unless your submitted application has already been approved.
- We reserve the right, in our sole discretion, to refuse any applicant for any reason.
- Applicants must be able to financially care for an animal.
Please answer each question completely, the more information you give to us the better we can match a pet with you and your family.
Today's Date

MonthDayYear
Date
Personal Information
Name*

First NameLast Name
Name Co-Applicant

First NameLast Name
Email*
example@example.com
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from Physical address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Age (Adopters must be at least 23 years of age)
Have you adopted from Mary's Kitty Korner before?

YesNo
If yes, name of the cat(s) and approximate date of adoption:
Are you financially able and willing to provide annual checkups, vaccinations, and ANY medical care necessary?

YesNo
Employer's Name:
Years Employed at present Job:
Does your employer do matching donations?*

YesNot sureNoNot sure, but will look into it
May we contact you regarding volunteering opportunities?

YesNoI will contact you
Living Situation
Do you own or rent:

OwnRentLive with ParentsOther
Are pets allowed?

YesNoNot sure
If you rent, What is the name of your landlord?

First NameLast Name
Landlord's Phone Number

Area CodePhone Number
If you move, what is your plan for the family pets? What would you do if pets were not allowed?*
What arrangements will you make if you are permanently unable to care for the cat(s) at any point? (such as allergies developing, emergency, one passes away, natural disaster, or any other things one cannot control)*
The average cat can live up to 20+ years. A lot can happen in this time. Under what circumstances would you not be able to keep this pet? (think ahead for the next 15 or more years) (Check all that apply)*

MovingConflict with other petsNew babyCat's BehaviorIllness or AllergiesSeparation/ DivorceKids lose interestSheddingCat's HealthClawing at furnitureMonetary IssuesWould not give up for any reasonNew JobToo time consumingOther
How many people live in your household?
If you have children under 18, please list their ages:
How much experience do the children have with cats?
Does anyone in your house smoke?

YesNoSometimes
How would you describe your household?

A place with constant activity and noiseSometimes noisy, sometimes quietQuiet and calm most of the time
Does any member of the family have allergies to animals?

YesNoNot Sure
Have you discussed adopting a cat in your home?

YesNoNo, it's a gift
How many hours a day will the cat be alone?
Finding a Good Match
Which cat(s) are you interested in? (There may be other applications on the cat(s) for which you are applying, please note it is not a first come, first served basis. If there are multiple applications, when possible, we will let the applicants know upfront and encourage them to select another cat(s) as a backup)
What qualities/personality traits are you looking for in a cat?
What is the intended purpose of adopting a cat? (Check all that apply)

Playmate for other petCompanion/ family petPlaymate for kid(s)GiftOther
Where will you keep your new cat?

IndoorOutdoorBoth
Who will be the primary caregiver for the cat?
Where will your new cat stay when no one is home?
Where will your new cat stay when you travel on vacation?
Where will the new cat sleep at night?
Do you plan to declaw your cat?

YesNoMaybe, Depends on the cat
What is the average yearly cost that you anticipate spending on your new cat? (include food, vet bills, litter, toys, etc.)
What would you do if your cat scratched or nipped you?
How do you plan on training your new cat not to scratch the furniture?
Current & Past Pets

Current Pets:

	Name of pet	Type of pet	Spayed/ Neutered Yes or No	If Cat, Declawed? Yes or No	Our pet is kept (In, Out or Both)	Age	Is the pet current on Vaccinations? Yes or No
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Pet 6
Pet 7

Past Pets: (that have past away or no longer with you)

	Name of pet	Type of pet	Spayed/ Neutered Yes or No	If Cat, Declawed? Yes or No	Our pet was kept (In, Out or Both)	Age	If still living but not with you, why and where are they?	If Passed, what was the cause?
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Pet 6
Pet 7

If you currently have a dog or dogs, please list the breed(s):
Have all of your current cats been tested for FeLV/FIV?

YesNoMost of themNot sure
The test results came back as:

PositiveNegativeBoth (multi-cat house)
How often does/did your pet(s) visit their veterinarian?

YearlyNeverEmergencies onlyOther
Are any of your current cat(s) on any medications or special food/diet?

YesNo
If Yes, Please describe what medications and/or special food and why:
Veterinarian Information

Many vets now require owner's permission to disclose vet history. PLEASE contact your vet(s) listed below to tell them a representative from Mary's Kitty Korner will be calling for this history. This will help us to process your application without delay.
Current Vet's Name

First NameLast Name
Current Name of Vet Practice
Current Vet's Phone Number

Area CodePhone Number
Name under which records are kept

First NameLast Name
List the names of the pets for Current Vet
If you brought your pet's elsewhere for shots or medical care please list that vet/location as well. Any gaps in vet history will hold up the application process.
Past Vet's Name

First NameLast Name
Past Name of Vet Practice
Past Vet's Phone Number

Area CodePhone Number
Name under which records are kept

First NameLast Name
List of the names of pets for Past Vet
References

If you do not have a vet, because this is your first pet or the first pet while living on your own, please list two personal references:

Personal References

	Full Name	Relationship	Phone number	E-Mail
1st Reference
2nd Reference

Statement of Understanding

By signing below, I acknowledge that I understand everything that I have read in this application and answered all of the questions truthfully. I also understand that any knowingly false or incomplete answers may cause my application to be denied.

I am 23 years or older and will be able to provide a picture ID upon picking up my new family member.

I understand that once approved, my application is valid for 60 days. After 60 days, I will have to fill out a new application.

I herby give a representative of Mary's Kitty Korner, Inc. permission to contact my landlord and veterinarian (if applicable) to verify any of the information supplied in this application.

I further understand that Mary's Kitty Korner, Inc. reserves the right to do a home visit before approval and is considered the guardian of the animal in question and has the right, in its sole discretion, not to approve this application.
Signature

Clear
Date

MonthDayYear
Date
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