First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

County

Email*

Home Phone

Work Phone
x

Cell Phone

What is your date of birth? *

What is your current employment status?*
Choose one: Employed Full Time Employed Part Time Unemployed Retired

Occupation?*

Which cat are you interested in?
Choose one:

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

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

Do you have children at home?*
Choose one: No Yes

If Yes, what are their ages?

Is anyone in your home allergic to dogs?*
Choose one: Yes No I don't know

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

Please provide your Landlord's name*

If you rent, how much is your pet deposit to allow dogs?*

Please list all current pets in your household, including name and type of animal (e.g. Sparky, dog). If none, please type "none".*

Please list any other pets you have owned in the past 10 years, including name and type of animal. If none, please type "none".*

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

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

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

Do you consider pets as part of your family?*
Choose one: Yes No I don't know

Who will be the principal caretaker of your new pet?*

Do you have a plan for your pet in the event something happens to you and you are no longer able to care for it?*
Choose one: No Yes

If yes, please explain:

Please list the name and phone number for the veterinarian/veterinary clinic that has provided medical care to your pets (current and past) below. (Out of area vets are acceptable.) ****If the records are under a different dog(s) name or client name, please let us know, so your application doesn't get delayed in processing*****