EmailMe Form - Adoption Application

Adoption Application

*** NOTE: THERE IS A GLITCH SUBMITTING THIS FORM WITH APPLE I-PHONES - PLEASE PRINT IT, FILL OUT A HARD COPY OR USE A DIFFERENT DEVICE ***

** Applications for kittens under 7 months old MUST BE SUBMITTED IN PERSON. Online applications WILL NOT BE PROCESSED **

Also, we are inundated with applications currently. If you want a cat right away, please check with the Humane Society, MADACC or one of the other rescues. We are at least two weeks behind.

Please complete the following information. Incomplete forms will NOT be submitted. If you rent we need the landlord's name AND phone number. If you do not have a vet we need TWO references (preferably not family) with PHONE NUMBERS. Thank you for understanding.

Today's Date *
MM / DD / YYYY
Name of cat(s) you are interested in? *
From which location did you see said cat(s)? *
Have you spent quality time with the cat(s) you are interested in? *
HOUSEHOLD INFORMATION
Your Name *
Please include first, middle and last name.
Your D.O.B *
MM / DD / YYYY
Email
Home Phone *
### - ### - ####
Cell Phone
### - ### - ####
Your Address *

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

____________________________________________________
Do You... *
Is it a... *
Does your lease or renter's agreement allow pets? *
Landlord's Name (if applicable)
Landlord's Phone Number (if applicable)
How long have you lived at your current residence? *
Years/Months?
List of others in your household (including children). Please include their name (first and last), age and relation to you. If not applicable, put N/A. *
PET CARE INFORMATION
Are there any other pets in the home? *
How many cats? *
Name, Breed, Ages and length of ownership of each cat in household: *
NAME/BREED/AGE/LENGTH OF OWNERSHIP

SHADOW/BLACK DSH/8 YEARS OLD/8 YEARS

If none, put N/A.
Are they spayed/neutered? *
Are they up to date on shots? *
Are they kept... *
______________________________________________
How many dogs? *
Name, Breed, Ages and length of ownership of each dog in household: *
NAME/BREED/AGE/LENGTH OF OWNERSHIP

EXAMPLE: BUSTER/GERMAN SHEPHARD/5 YEARS OLD/4 YEARS

If none, put N/A.
Are they spayed/neutered? *
Are they up to date on shots? *
Are they kept... *
____________________________________________________
What animals have you owned in the past 5 years? *
SPECIES/NAME/AGE/SEX/LENGTH OF OWNERSHIP

EXAMPLE: CAT/WHISKERS/15 YEARS OLD/M/14 YEARS

If none, put N/A.
Have you ever lost any of your pets listed above to illness or have you ever had to give one up (Be it to a friend, family member or shelter)? If so, please explain: *
If no, put N/A.

___________________________________________________
Please rate your household’s activity level: *
What is the intended purpose of this cat? *
Where will the cat stay while you are gone during the day? Where will it sleep at night? *
What will happen to the cat if you move? Have children? *
If you become unable to care for the cat, what arrangments will be made for the cat’s care? *

___________________________________________________
Would you prefer to de-claw a cat? *
If yes, Why?
Does your landlord require that cats be declawed? *
Are you willing and financially able to take the cat to a veterinarian for annual physicals and vaccinations? *
Are you prepared to make a 15 - 20 year commitment to this cat? *
Would you have a problem with a Happy Endings rep. delivering the cat to your home? *
If yes, Why?
REFERENCES
Please provide either your current veterinarian OR two personal references with phone numbers (non-family) that we can call.

IF LISTING A VET, PLEASE CONTACT THEM AND GIVE THEM PERMISSION TO RELEASE YOUR RECORDS TO SPEED UP THE ADOPTION PROCESS.
Please provide your veterinarian's/reference 1 name: *
A VET IS REQUIRED IF YOU CURRENTLY HAVE ANIMALS OR HAVE HAD PETS IN THE PAST YEAR. IF YOU HAVE AN ANIMAL AND DO NOT HAVE A VET BUT WOULD LIKE SUGGESTIONS PUT (NO VET) AND THEN LIST YOUR REFERENCE.
Reference 2 name AND phone number: *
If none, please put N/A

Image Verification

Please enter the text from the image:
[Refresh Image] [What's This?]

HOUSEHOLD INFORMATION

PET CARE INFORMATION

REFERENCES