Adoption Application & Questionaire

Date:

Name (Last, First):

Co-Applicant Name (Last, First):

Address:

City: State: Zip code:

Phone: Phone: email:

Birth Date: Relationship to Co-Applicant:

Home & Household Information

If you rent your home, you are required to provide verification that the landlord allows pets. If you live with your parents, you are considered a renter.

What type of Housing do you live in: . Single Family Home Townhome/Duplex Apartment Mobile Home Do you own or rent: . Own Rent

Please list each person who resides in your home (including children + ages, roomates, friends):

Please list the pets in the past 15 years that are you were financially responsible for. Please do not list childhood pets that your parents cared for:

Please complete below information regarding current pets

Have you had any additional pets in the last five years?  Please list the species, age and reason you no longer own them.  Lost, put to sleep (reason), given away (reason).

Veterinarian Name Veterinarian Phone:

Have you ever adopted from us or another rescue/shelter?

Rescue name: When: Which pet:

Employment Information

Application Employer: Phone:

Position: Hours worked: Shift

Co-Application Employer: Phone:

Position: Hours worked: Shift

Type of cat you are interested in:

Sex of cat: . Male Female no preference Age of cat: . kitten under 1 yr adult cat Senior no preference Is this cat a gift:

Reason you want to adopt:

Will the cat be allowed outside? . yes no unsure Do you plan to Declaw? . yes no unsure

The adopter understands that the feline comes with no warranty as to health, temperament, future behavior, breed or appearance; and that Paws and Purrs Humane Society is not responsible should this cat bite, scratch, or harm any animal, person, or property in any way once you adopt. By signing or typing your name below, I certify that the information I have given is true. I understand that Paws and Purrs Humane Society reserves the right to deny my application for any reason at any time. I further authorize the investigation of all statements in this application.

A value is required.Signature

Additional Comments / Notes: