First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

County

Email*

Home Phone

Work Phone
x

Cell Phone

Date of Birth *

Name of spouse or partner-

Fill out the application COMPLETELY, incomplete application will not be processed.

What cat are you interested in?
Choose an animal: Belle Bomax Drax Loki Matilda Monkey Moon Mr. Peachy Pipa Razz Titan Tuff Tuff Wizard Zelda

What type of home do you live in?*
Choose one: Apartment Condo Farm House Mobile Home

Do you own or rent your home?*
Choose one: Rent Own

Landlord's name (If a complex, list manager's name and/or rental office)

What is your landlord's phone number?

What is your landlord's email address?

If you rent, does your lease agreement allow dogs and cats and are there restrictions?
Choose one: Yes No I don't know

How many adults live in your home?*
Choose one: 1 2 3 4 5 6 7 8 9 10

How old are the children in the home?
Choose all that apply: No Children 0-2 3-5 6-11 12-17

Is anyone in the home allergic to cats?*
Choose one: No Yes

List all current pets by their name and what type of animal they are(e.g. Sparky, dog).

List any pets you have owned in the past 10 years that you no longer have by name and type of animal.

List the name of your CURRENT (or most recent) veterinarian

Your current vet's phone number is

List the name and phone numbers of all veterinarians used within the PAST 10 years. (list all regular and emergency vets)

What name and phone number are the vet records under? (List ALL possibilities)

Will you have your pet spayed or neutered?*
Choose one: Yes No

Will your pet(s) be kept inside or outside?*
Choose one: Inside Only Outside Only Inside and Outside

Are your current pets up to date on their vaccinations and monthly preventatives?*

For cats only: Have you had a cat declawed? *
Choose one: Yes No

Have you ever had to return or surrender an animal in the past?*
Choose one: Yes No

If yes, please explain:

Have you ever had to euthanize a pet?*
Choose one: Yes No

If yes, please explain

If for some reason you are not able to care for this pet in the future, do you have a plan for someone to take over and care for your pet?*
Choose one: Yes No

If yes, please explain:

List two (2) references including name, phone number, and email. (No family members and they do not have to be local references)*