Cat Adoption Application

Hidden

Default: Cat Adopter Status

First Name*

Last Name*

Age Range*

eMail Address*

eMail Address Confirm eMail Address

Street Address*

Suite | Apt or Unit Number

City*

State/Province*

ZIP*

Country*

Home Phone Number

Work Phone Number

Cell Phone Number*

Preferred Method of Contact

Employment & Schooling

Are You Employed?*

Yes

Full or Part Time?*

Name of Employer*

How Long Employed There?*

Are You in School?*

Yes

Full or Part Time?*

How Did You Hear About Us?*

What Is Your Friend's Name?*

Which Shelter?*

Which Rescue?*

Please Describe*

Below are three areas for information on other members of your family. Please include all other adults, children and pets living in your home by clicking on the designated button.

Are There Other Adults In The Home?*

Yes

Add Adults

First Name	Last Name	Age Range	Are You Employed?	Actions

There are no Adults.

Maximum number of adults reached.

Do You Have Children In The Home?*

Yes

Add Children

Name	Age	Gender	Previous Experience with Dogs:	Actions

There are no Children.

Maximum number of children reached.

Are There Other Cats In The Home?*

Yes

Add Cats

Cat's Name	Breed	Age Range	Gender	Actions

There are no Cats.

Maximum number of cats reached.

Are There Other Pets In The Home?*

Yes

Add Pets

Pet's Name	Animal Type	Sleeping Quarters	Actions

There are no Pets.

Maximum number of pets reached.

Residence

Type of Residence*

Please Describe Type of Residence*

Do You Own or Rent?*

Does Landlord Allow Cats?*

Yes

Please Provide Landlord's Name*

Please Provide Landlord's Phone Number*

Yard Information

Do You Have A Yard?*

Yes

Is The Yard Fenced?*

Yes

How High Is The Fence?*

What Is The Lowest Point of The Fence?*

What Material Is The Fence Made From?*

Please Describe Fence Material*

Is The Lawn Treated?*

Yes

Do You Have A Pool?*

Yes

Is The Pool Completely Fenced?*

Yes

Family & History

What Type Of Household Do You Have?*

Please Describe*

Do All Family Members Want A Cat?*

Yes

Please Explain Who Doesn't and Why They Don't*

Is Any Member Of Your Household Allergic To Cats?*

Yes

Have You Ever Had A Cat Before?*

Yes

Which Cat Breed?*

How Long Did You Own Him/Her?*

Where Did You Get The Cat?*

Was The Cat Spayed or Neutered?*

Yes

Was The Cat Vaccinated Annually?*

Yes

Was The Cat On Heartworm Prevention?*

Yes

Which Years Owned?*

Please List and Describe Same Situations with Additional Pets*

Has It Ever Been Necessary To Give A Cat Away?*

Yes

Please Explain Why You Had to Give The Cat Away*

Has It Ever Been Necessary To Euthanize A Cat?*

Yes

Please Explain Why You Had to To Euthanize A Cat*

Are You Willing To Take Responsibility For This Cat For The Next 15-20 Years?*

Yes

What Provisions Will You Make For The Cat Should You Become Unable To Care For Him/Her?*

Are You Capable of Providing Timely Healthcare?*

Yes

What Are You Willing/Able To Spend On Annual Vet Care?*

Please Explain Your Circumstances*

Feeding & Exercise

Who Will Be Responsible For Feeding The Cat?*

Sleep & Alone Time

Where Will The Cat Sleep?*

Where Will The Cat Be When Alone?*

Please Describe Where The Cat Will Be*

Do You Have A Doggie Door?*

Yes

Is It Locked When You Are Away From Home?*

Yes

What Is The Longest Time The Cat Will Be Alone (without humans)?*

Who Will Care For The Cat While You Are On Vacation?*

Please Explain Who Will Care For The Cat*

Behavior & Training

Cats Can Take A Month Or Longer To Adjust To A New Home, Particularly If Other Pets Are Involved. Are You Willing To Devote This Much Time To Make The Cat Comfortable In Your Home?*

Yes

What Behaviors Can You Tolerate (and work on)?

Needs Social Skills*

Yes

Accidents In The House*

Yes

Inappropriate Chewing*

Yes

Excessive Scratching*

Yes

Separation Anxiety*

Yes

Other

Yes

Please Explain Other Behaviors You Cannot Tolerate*

Personal Reference

Please Provide A Personal Reference

Please Provide Reference's First Name*

Please Provide Reference's Last Name*

Please Provide Reference's Phone Number*

Please Provide Reference's eMail Address*

Relationship to Applicant*

Years Acquainted

Veterinarian Information

Have You Used A Veterinarian Before?*

Yes

Please Provide Veterinarian's Name*

Please Provide Veterinarian's Phone Number*

Groomer Information

Have You Used A Groomer Before?*

Yes

Please Provide Groomer's Name*

Please Provide Groomer's Phone Number*

Boarding Facility Information

Have You Used A Boarding Facility Before?*

Yes

Please Provide Boarding Facility's Name*

Please Provide Boarding Facility's Phone Number*

Reason For Adoption

Select all that apply.

Family Companion*

Yes

Breeding*

Yes

Farm Cat | Mouser*

Yes

For Child*

Yes

Gift*

Yes

Companion For Current Cat*

Yes

Replace A Previous Cat*

Yes

Other

Yes

Please Describe Why You Want This Cat*

Would You Consider:

Fostering While Waiting For The Perfect Cat?*

Two Cats?*

A Cat That Can Be An Only Pet?*

A Cat That Is Afraid Of Small Children?*

A Cat That Needs Medications?*

A Cat That Has A Serious Health Condition?*

Please Select All Health Condition(s) You Would Accept*

A Cat that Has Special Needs?

Please Select All Special Needs(s) You Would Accept*

Select All That Apply:

A Cat That is Litterbox Trained?*

Select Gender*

Select Age Range*

Select All That Apply

Select Personality*

Select All That Apply

Select Color*

Do You Have A Preferred Cat?

Note: This does not guarantee this cat will be placed with you

List Other Cats You Are Interested In*

When Will You Be Ready To Adopt?*

Is There Anything Else You Would Like to Let Us Know?

I am interested in receiving pet related services and products

Yes

Authorization

Authorization:*

All cats placed through the Mid Cities Animal Rescue will have health checks, personality and temperament evaluations, and will be spayed or neutered prior to placement unless a medical condition exists, diagnosed by a veterinarian, that would prevent this surgery. I understand that this is a preliminary application and that there may be no Cat available in rescue at this time. I understand that if a Cat should become available, that I will be required to provide further information including, but not limited to, personal and veterinary references. I further understand that all information on my Preliminary Rescue Adoption Application will be kept confidential; that my application will be kept on file until I notify the Mid Cities Animal Rescue that I am no longer interested in a rescue; and that I will not be contacted unless an appropriate Cat becomes available. I understand and agree *

I agree

Name

This field is for validation purposes and should be left unchanged.