EmailMe Form - Adoption Questionnaire

Name *

First Last

Email *

Phone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Occupation *

What is your experience with animals?

Do you rent or own your home? *

Rent

Own

Live with relatives

If you rent, does you landlord allow pets? *

Yes

No

Landlord's Name & Phone #

Are all adult members of your household in favor of this adoption? *

Yes

No

Unknown

Is anyone in your home allergic to cats? *

Yes

No

Unknown

What is the age of the youngest child living in your home? *

None

Under 6 years old

Over 6 years old

Why do you want a cat? *

Companion

For the children

Mouser

Help us find *

one kitten

a cat for our cat

a pair of feline

we are open

We were thinking *

the right personality for me *

cuddle bug

adventurer

rebel rouser

lap cat

Have you ever had a cat before? *

Yes

No

If yes, what happened to the cat(s) that you have had in the last five years (mark all that apply)? *

Do you have any other pets? *

Where will the cat be kept during the day?

Inside

Outside

Where will the cat be kept at night?

Inside

Outside

How many hours a day will the cat be left alone? *

Here is a little more information on my situation and what I am looking for: *

How did you hear about Kitty Bungalow?

Poster

Word of Mouth/Friend

Online

Other

The best time/day(s) for me to come and visit *

weekend days

weekday days

weekday evenings

Additional schedule info: