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 *
ARE YOU OVER 21 YEARS OF AGE?*

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
DO YOU OWN OR RENT?*

OwnRent
IF YOU RENT, PLEASE ATTACH YOUR RENTAL AGREEMENT.

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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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HAVE YOU OWNED A DOG(S) IN THE PAST*

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!
WERE YOUR PREVIOUS DOG(S) SPAYED/NEUTERED?*

YESNOI have not had dogs
DO YOU CURRENTLY HAVE DOGS*

YESNO
IF YES, PLEASE LIST THE NAME OF YOUR DOG(S), THEIR AGE AND THEIR BREED. Or N/A
IF YES, ARE THEY SPAYED/NEUTERED?*

YESNONo current dogsSome are spayed/neutered and some aren’t.
HAVE YOUR CURRENT DOG(S) BEEN TO THE VETERINARIAN WITHIN THE PAST YEAR?*

YESNONo current dogsSome have been to the veterinarian within the past year and some have not.
HAVE YOU OWNED CAT(S) IN THE PAST?*

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.
WERE YOUR PREVIOUS CAT(S)?*

Indoor/outdoorIndoor mainlyOutdoor alwaysIndoor onlyI have not had cats.
WERE YOUR PREVIOUS CAT(S) SPAYED/NEURDED?*

YESNOI have not had cats.
DO YOU HAVE ANY CAT(S) CURRENTLY?*

YESNO
IF YES, PLEASE LIST THE NAME(S), AGES OF YOUR CURRENT CAT(S).
ARE YOUR CURRENT CAT(S) SPAYED OR NEUTERED?*

YESNOI don’t have any current cat(s).
HAVE YOUR CURRENT CAT(S) BEEN TO THE VETERINARIAN WITHIN THE PAST YEAR?*

YESNONo current catsSome have been and some have not
ARE YOUR CURRENT CAT(S)?*

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)*
WILL THIS ADOPTED CAT(S) BE KEPT?*

Mainly indoorsOutdoorsIndoors/sometimes outdoorsIndoor only
DO YOU PLAN TO DECLAW THIS CAT IF YOU ADOPT?*

YESNO
WHAT IS THE NAME & PHONE # OF YOUR CURRENT VETERINARIAN?*
ARE YOU FINANCIALLY PREPARED TO PROVIDE THE NECESSARY CARE FOR YOUR PET: PROPER FOOD, VACCINATIONS, PARASITE CONTROL (FLEAS, TICKS, WORMS, ETC.), ADEQUATE SHELTER, AND VETERINARY CARE FOR YEARLY CHECK-UPS AND MEDICAL EMERGENCIES?*

YESNO
HAVE YOU EVER PLACED A PET IN AN ANIMAL SHELTER?*

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
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