First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Cell Phone

Which animal are you interested in
Choose an animal: Cats Dexter-Sponsor Eva Gino Griffin Reggie Sienna

Please list the names and ages of everyone in the household (include yourself)

Does any member of your household have cat allergies?

Are you committed to taking full responsibility for your adopted pet's health and welfare for the rest of it's life, which could be 15 years or more?

Are you financially prepared to handle a medical emergency if necessary?

List two references and their contact information (one who is not a family member)

Why are you interested in adopting at this time?

If you have cats, where do they usually stay?
Choose one: Inside Only Outside Only Inside and Outside

For cats only: Are you planning to declaw
Choose one: Yes No

Under what circumstances would you give up your pet? (check all that apply)

Have you ever given up a pet? If yes, please explain

In what type of home do you live?
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

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

If you rent, please enter your landlord's name and phone number

List all animals currently living in your home. Provide name, type/breed, age, sex, if spayed/neutered and how long you have owned.

List all Veterinarians you have used and their contact information (if the pet is listed under a different name than the one on your application please provide that name)

How did you hear about us?

Would you like to be added to our email list for news and updates?

Would you like to receive pet nutrition/wellness information and specials? Any purchase helps raise money for our animals!

I understand the adoption fee will be as follows: $125 for 1 kitten/cat or $150 for 2 kittens/cats (unless otherwise discussed with the Director). We do not receive any funding and rely on adoption fees to be able to continue the work that we do.

I understand that the adoption fee is non-refundable

I understand that a home visit may be required. Is this acceptable to you?

Comments/Any other information you would like to provide?