Applicant:

First Name: Last Name: Age: Occupation:

Co-applicant (Spouse or Significant Other):

First Name: Last Name: Age: Occupation:

Street address:

City: County: State: ZIP:

Home Phone: Cell Phone:

E-mail (required field):

NAME OF CATS:

List any general questions you would like to ask about this particular pet:

Are you willing to allow a Furkids representative visit the cat in your home? Yes No

Please check any of the following reasons for adopting this pet: companion for family companion for myself companion for other pet gift other - please specify:

Do you have children? Yes No

If yes, please list their gender(s) and age(s):

Is everyone in the household in favor of adopting a cat? Yes No

Does anyone in the household have allergies to cats? Yes No

If yes, please list who:

Please list all of your current pets: (i.e. cat/type of dog, age/gender)

What is your veterinarian's name and phone number?

Are all current pets spayed/neutered? Yes No

How many pets have you owned in the past?

Please describe what happened to each of them (put to sleep, run over, died of old age, sold, given away, ran away, etc.)

Where will your new cat stay when home alone during the day? outside inside both

Will you declaw this cat for any reason? Yes No Unsure

What circumstances, in your mind, justify giving a pet up? moving to another state or residence where cats are not allowed new baby, new spouse, roommate clawing/scratching furniture allergies, or relationship with person who has allergies other - please explain:

Do you own the residence where the cat will live? Yes No

If NOT the owner, how long have you lived at this residence?

If NOT the owner, are pets allowed at this residence? Yes No

If NOT the owner, is there a pet deposit required? Yes No

Please list the name and phone number of the Lanlord/Management Company:

If you are unable to keep your pet for any reason at any time will you return the pet to us?
Yes No

Please list the names, addresses and phone numbers of 2 personal references:

How did you hear about our organization? website magazine/newspaper word of mouth referral at an adoption center other - please specify:

Typing your name below will serve as legal signature.

By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue pet and possible removal of said pet from my home. Applicant must be 21 years of age or older. Furkids reserves the right to refuse any applicant.