Adoption Application~

Date:

___________________________

Adoption fee:$____________________

For Office Use Only

CCI Volunteer Name:__________________________Approval: Yes No Pending O
Reason:_____________________________________________________________________

Please indicate the animals name(s) for which you are applying: _______________________________________
Name: _______________________________________________________________________________________
Address: _____________________________________________________________________________________
Town, City: _________________________________________Postal Code________________________________
Telephone:home: ______________________work:______________________cell:__________________________
Email Address: _______________________________________________________________________________
Do you live in (check one): single-family home apartment O mobile home other__________________
Do you live with your parents?

Yes

No If yes do they approve of you getting a cat? Yes No

Parents phone #_____________________________________We will be contacting them before approval

Do you own or rent your home? Rent Own....If you rent, please provide the following information:
Name of Landlord: _____________________________________________________________________________
Address: ________________________________________________________________________________________________________
Telephone Number: _____________________________________________________________________________
Please provide the names and ages of all individuals residing in your home (including yourself):
Name
Age
Name
Age

Are you willing to work with behavioral problems? O Litterbox O Scratching furniture O Fearful O Shy

O Nervous O Socialization Problems O I am not interested in working on problems O I need more information
to decide.
How would you handle behavioral issues:___________________________________________________________

Claw sharpening is a natural behaviour for cats. They will need a tall scratching post. Do you know the
appropriate places to have post so cats will use them?_________________________________________________
Would you ever have the cat declawed? O Yes O No Why:____________________________________________
Do you know that declawing is not a simplesingle surgery but 10 separate, painful amputations of the third
phalanx up to the last joint of each toe? A graphic comparison in human terms would be the cutting off of a
person's finger at the last joint of each finger.
Who are you adopting this cat for? O Self O Friend O Other _________________________
Have you ever owned a pet before? Yes No
Please list your pets (living and deceased within past 5 years):
Type of Pet
Name
Age or
Is the animal
Vet Name and
Spayed/
Deceased
current on
Phone Number
Neutered
(if deceased
indicate year
and cause)

vaccines?

What brand of food do you feed your animals (example: Purina Pro Plan)? ________________________________
(if no current animals, what brand and variety of food have you fed in the past?)__________________________
Where do you keep your current pets?

Inside

Outside

Both Describe_______________________

Where do you intend to keep this pet?

Inside

Outside

Both Describe______________________

Where will this animal sleep? Crate Cat Bed

Family Members Bed Basement

Garage

O Other: describe______________________________________________________________________________
How long will this pet be left alone each day (crated or otherwise unattended include time before and after a
break if someone comes home for lunch)? Briefly describe your household (eg children, work hours, activities)
______________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________

Who will be the cats primary caretaker?___________________________________________________________

Have you had cats before? O Yes O No
What happened to them?_________________________________________________________________________
Have you ever given up a pet for adoption? Yes

No

If yes, please explain why, and where the pet is now: ___________________________________________________

___________________________________________________________________________________
_____________________________________________________________________________________________________________

Under what circumstances would you give up a pet? _____________________________________________________

______________________________________________________________________________________________
______________________________________________________________________________
Do you currently have or have you recently had any cats or kittens which have Feline Leukemia, Feline Aids,
Distemper Virus or any Upper Respitory Infection Yes No
If yes, please explain how you intend to keep this pet separated from the infected pet(s):_________________
_________________________________________________________________________________________________________________

Do you have any family members with allergies or other health conditions that may impact the outcome of this
adoption? Yes No
If yes, please explain: _________________________________________________________________________

___________________________________________________________________________________________
Please provide the following information for all current and deceased pets (within the past 5 years):
Name of Veterinarian: _______________________________________________________________________
Address: ___________________________________________________________________________________
___________________________________________________________________________________________
_________________________________________________________Telephone Number: _________________

We will be calling your Vet for Reference pertaining to prior animal care
What veterinarian do you intend to use for this pet? ___________________________________________________________
Phone #______________________________________________
Please list two, (2) character witnesses who do not live with you:
** One reference should be a non-relative

Name

Phone Number and/or Email

Relationship**

Briefly describe why you feel you would be the right home for this animal:
______________________________________________________________________________________________

______________________________________________________________________________________________
Adopting an animal is a big responsibility. The animal for which you are applying will be totally dependent on
you for all of its needs for the REST OF ITS LIFE. This includes medical care and training.
On an annual basis, what do you think an animals medical care costs are including teeth cleaning, deworming,
defleaing? $ ___________
How much are you willing to spend annually for your pets medical care? $______________
Will you be able to provide emergency medical care financially? O Yes

O No

How much do you believe an emergency Vet. appointment will cost? $_____________
Are you willing to make a life-long commitment to this animal? Yes

No

By signing this application, you are consenting to allow a CAT CARE S/N Initiative Representative entrance into
your home for a compatibility assessment
By signing this application, you are consenting to allow a CAT CARE S/N Initiative Representative to contact your
veterinarian to obtain pet history and medical information.
Please read and sign below:
I certify that all information in this application is true. Furthermore, I understand that if the
information contained herein is found to be false, my application will be voided and any
pending adoption refused.
Applicant Signature:______________________________________Date:___________________________________

Photo of Cat:
for Official Use: