EmailMe Form - SIMPLY SOUTHERN RESCUE FELINE ADOPTION APPLICATION

Date Time

MM / DD / YYYY

Name

First Last

Address

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

Phone

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

Email

Date of Birth

Drivers License #

Name of cat you are interested in

Do children live in your home?

Yes

No

If yes, what are their ages?

Do you own any other pets?

Yes

No

Please list name, age, and type of other animals in the home

Do you rent or own your home

Rent

Own

If you rent, are you allowed to have indoor pets?

Yes

No

Will the cat stay inside or outside?

Inside

Outside

What is the activity level of your home

Very quiet

Moderately quiet

Active

Very active

Have you ever surrendered a pet to a rescue or animal shelter

Yes

No

If yes, why?

Pets are expensive, can you afford proper vet care and quality food?

Yes

No

Do you agree to provide yearly vaccinations and worming for this cat?

Yes

No

Who is or will be your vet? Please include name, address, and phone...

What will you do with your cat if you have to move?

I would NOT be able to keep the cat under the following circumstances

In your opinion what makes a good pet owner?

**Do you agree to return this cat to SIMPLY SOUTHERN RESCUE if for any reason you can no longer care for it, with a non-refundable adoption fee?

I understand that SIMPLY SOUTHERN RESCUE reserves the right to seize any cat that is not being cared for properly.

I understand that SIMPLY SOUTHERN RESCUE is not responsible for any damage or physical harm caused by this cat.

I understand that all future medical expenses past this date, are my full responsibility.

I agree that I have answered the questions to the best of my knowledge and have not knowingly submitted false or misleading replies.

Adoption fee: $35 cash only

PLEASE SIGN