Pet Connection, Inc. Cat Adoption Form

Pet Connection, Inc. Cat Adoption Form

Email: pet_connection@hotmail.com Phone: 724.697.5262
YOUR NAME*

First NameLast Name
EMAIL*
example@example.com
PHONE NUMBER*

Area CodePhone Number
NAME OR DESCRIPTION OF THE CAT(S) YOU WANT TO ADOPT *
YESNO
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HOW LONG AT THIS ADDRESS?*
IF LESS THAN 2 YRS., WHAT WAS YOUR PREVIOUS ADDRESS? (Type N/A if not applicable)*
CELL PHONE*

Area CodePhone Number
OTHER PHONE

Area CodePhone Number
OwnRent
IF YOU RENT, PLEASE ATTACH YOUR RENTAL AGREEMENT. (We will not be able to proceed with your application until we verify that your property allows pets.)

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IF YOU ARE UNABLE TO PROVIDE YOUR RENTAL AGREEMENT, PLEASE PROVIDE YOUR
PROPERTY MANAGER'S OR LANDLORD'S CONTACT INFO.
First Name   Last Name
Email
Area Code   Phone Number
WHAT ARE THE AGES OF EVERYONE LIVING IN YOUR HOME?*
WHAT IS YOUR OCCUPATION? (If applicable, or N/A, retired, student, homemaker, etc.)*
EMPLOYMENT STATUS*
WHAT IS YOUR EMPLOYER'S NAME (If applicable, or N/A)*
HOW LONG HAVE YOU WORKED THERE? (If employed, or N/A) *
# of years
WHAT IS YOUR SUPERVISOR'S NAME?*
PLEASE PROVIDE THEIR CONTACT PHONE NUMBER OR EMAIL.*
IF YOU'VE WORKED LESS THAN TWO YEARS AT YOUR CURRENT EMPLOYER, WHO WAS YOUR PREVIOUS EMPLOYER? (Type N/A if not applicable)*
SPOUSE OR PARTNER'S OCCUPATION (if applicable, retired or N/A)*
SPOUSE OR PARTNER’S CURRENT EMPLOYER (if employed, or N/A)*
HOW LONG HAS YOUR SPOUSE OR PARTNER WORKED AT THEIR CURRENT PLACE OF EMPLOYMENT (if employed, or N/A)*
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YESNO
IF YES, WHAT HAPPENED TO THE DOG(S)? Please explain in detail. WHAT MEDICAL DISEASE DID HE/SHE PASS FROM? Please don’t say “died of natural causes.” We seriously consider applicants who provide us with past veterinarian references!
YESNOI have not had dogs
YESNO
IF YES, PLEASE LIST THE NAME OF YOUR DOG(S), THEIR AGE AND THEIR BREED. Or N/A
YESNONo current dogsSome are spayed/neutered and some aren’t.
YESNONo current dogsSome have been to the veterinarian within the past year and some have not.
YESNO
IF YES, WHAT HAPPENED TO THE CAT(S)? WHAT MEDICAL DISEASE DID HE/SHE PASS FROM? Please don’t say, “died of old age." Please explain in detail. If no previous cats, reply with N/A.
Indoor/outdoorIndoor mainlyOutdoor alwaysIndoor onlyI have not had cats.
YESNOI have not had cats.
YESNO
IF YES, PLEASE LIST THE NAME(S), AGES OF YOUR CURRENT CAT(S).
YESNOI don’t have any current cat(s).
YESNONo current catsSome have been and some have not
Indoor/outdoorIndoor mainlyOutdoor alwaysIndoor onlyI don’t have any cats.
iF YOU HAD ANY PET(S) IN THE PAST, PLEASE PROVIDE THE NAME OF THE VETERINARIAN HOSPITAL, THE PHONE NUMBER OF THE HOSPITAL, THE PET(S) NAME, AND THE NAME OF THE INDIVIDUAL THE RECORD WAS UNDER. (Or N/A if no past pets)*
Mainly indoorsOutdoorsIndoors/sometimes outdoorsIndoor only
YESNO
WHAT IS THE NAME & PHONE # OF YOUR CURRENT VETERINARIAN?*
YESNO
YESNO
IF YES, WHAT WAS THE REASON?
BY TYPING MY FULL NAME BELOW, I AFFIRM THAT ALL INFORMATION ABOVE IS TRUE. I REALIZE THAT THIS IS A LIFETIME COMMITMENT AND AGREE TO GIVE THIS PET A SAFE, HEALTHY HOME. IF THERE ARE PROBLEMS WITH THIS PET, OR I MUST GIVE IT UP, I AGREE TO RETURN IT TO PET CONNECTION, INC.*
TYPE FULL NAME HERE
Enter the message as it's shown*
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