Cat / Kitten Adoption Application All applications are subject to review by the Adoption Committee. Completion of this application does NOT guarantee an adoption. All items marked with an asterisk must be provided. Please enter NA to items that may not pertain to your situation. Step 1 of 4 25% Pet Information Cat or Kitten*CatKittenPet's Name*Animal IDApplicant InformationName*FirstLastApplicant's Date of Birth* mm/dd/yyyyAddress*Street AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZip CodePreferred Phone*Second PhoneEmail* Have you adopted from an animal adoptive group before?*YesNoName of adoption organization?Do you still have the pet?YesNoIf No, why?Are you adopting for:*YourselfImmediate FamilyFriend / RelativeChildBusinessOtherOtherHow many people live in your home? *Number of children? *Children's ages?Does anyone in the household have animal allergies? *YesNoWho?Why are you adopting a cat? (check all that apply): *Family PetGiftChild's PetCompanion for another petMouser / Barn CatAdult CompanionOtherOtherWhich veterinary clinic do you use? What is their phone number?*Please check applicable living situation (all that apply):*Own HouseOwn Mobile HomeOwn Condominium / TownhouseRent HouseRent Mobile HomeRent Apartment/TownhouseRent DuplexRent DormLive with RoommateLive with Parent / Guardian in their homeIf you rent, landlord / complex name?*FirstLastIf you rent, landlord / housing complex administration phone number?*Please enter the phone number as ##########. No parentheses () or dashes -. If you have a roommate, list name*FirstLastIf you live with parent/guardian in their home, list name*FirstLastOn average, how many hours per day is someone at home on weekdays (excluding sleeping hours)?*On average, how many hours per day is someone at home on weekends or days off (excluding sleeping hours)?*What will you do with your cat when you must be out of town?*Cat’s/kitten's primary living quarters will be:*InsideOutsideBoth EquallyWhere will the cat/kitten stay while you are away from home for work or school?*Loose OutsideConfined in Garage / BarnLoose in HomeCratedConfined to a RoomBasementWhere the cat/kitten sleep at night?*Free run inside homeConfined to a roomBasementIn bed with ownerCratedGarage/PorchYard or penPlease describe what you feel are the characteristics of the ideal cat for you/your family.*Do you plan to spay/neuter?*YesNoAlready AlteredHow many years do you plan to keep this cat/kitten? * Begin: Start of your animal historyHow many pets have you owned in the past?*12345First animal's name / sex?First animal's breed?First animal spayed / neutered?YesNoFirst animal's age when acquired?First animal's current age?First animal still a family member?YesNoIf first animal is deceased, at what age?For first animal, what happened if not still owned?First animal's health / behavior problems?Second animal's name / sex?Second animal's breed?Second animal spayed / neutered?YesNoSecond animal's age when acquired?Second animal's current age?Second animal still a family member?YesNoIf second animal is deceased, at what age?For second animal, what happened if not still owned?Second animal's health / behavior problems?Third animal's name / sex?Third animal's breed?Third animal spayed / neutered?YesNoThird animal's age when acquired?Third animal's current age?Third animal still a family member?YesNoIf third animal is deceased, at what age?For third animal, what happened if not still owned?Third animal's health / behavior problems?Fourth animal's name / sex?Fourth animal's breed?Fourth animal spayed / neutered?YesNoFourth animal's age when acquired?Fourth animal's current age?Fouth animal still a family member?YesNoIf fourth animal is deceased, at what age?For fourth animal, what happened if not still owned?Fourth animal's health / behavior problems?Fifth animal's name / sex?Fifth animal's breed?Fifth Animal spayed / neutered?YesNoFifth animal's age when acquired?Fifth animal's current age?Fifth animal still a family member?YesNoIf fifth animal is deceased, at what age?For fifth animal, what happened if not still owned?Fifth animal's health / behavior problems?End: Finished with your animal history Are you prepared to deal with the cost of both routine vet care (e.g. annual shots, worming) and non-routine emergency vet care, especially as the animal gets older? *YesNoWhat situation/problem would force you to give up a cat? (Check all that apply)*Pet Behavior Problem (i.e. destructive, litter trainingMovingBirth of ChildDivorceOwner Illness/DeathFamily Member Allergies Desire of New Family Member / Significant OtherLifestyle ChangeOther Other If you had to give up your pet, would you? *Give it awayTake it to the nearest shelterSell it Return it to ACSTurn it loose to find a new homeOtherOtherPlease list 3 references not living with you. Only 1 may be a family member. All references must be 21 years or older. Please list a phone number for each reference & your relationship to each reference. *Use each reference as a new line name , Relationship , PhoneIf approved– How do you intend to pay?*CheckCredit Card CashCertification Although I understand that every animal adopted has been inspected and its history reviewed, I appreciate that you can make no warranty in regard to the pet and that you can give me only such information as you have received with regard to the pet. If, for any reason, I am not able to care for my adopted pet, I will contact the Animal Care Society for acceptance into the Center and readoption. The Society will determine whether or not the pet can be accepted for readoption, or for including the pet in its referral for adoption records. If the Animal Care Society demands the pet’s return for any reason, I agree to promptly return the pet to the Center. I shall be personally responsible for the humane care and control of the pet and I agree that your agent shall be allowed to see the pet at any reasonable time. I further understand that any donation I have given to the Animal Care Society is a donation towards its work in caring for pets. Applicant Signature ______________________________ Date ______________________ ACS Witness _____________________________________ Applicant Information
