Pet's Name:
First Name:		Last Name:
E-mail:
Address:
City, State, Zip:

Cell Phone:

Work Phone:

Home Phone:

Are you 18 years old or older? Yes No

Do you live in a home townhome or apartment?      Do you own or rent your home?

If you rent, do you have written permission from your landlord to own a pet? Yes No

If renting, landlord's name and phone:
How long have you lived at this address?:		Do you have plans to move?:

FAMILY/HOUSEHOLD INFORMATION

Are there children in the household? Yes No What are their ages?

Is anyone in the household allergic to cats? Yes No

Do you expect your current family situation to change?: Yes No

Are all family members in agreement about this adoption? Yes No

Why are you considering adopting a cat?

Companion for self    Companion for child   Companion for another household member Gift    Other reason for adopting:

It's most important to me that my cat:

PET INFORMATION
Have you had pets in the past or do you currently have pets? Please tell us about them
Name	Breed	Age	Gender	Spayed/Neutered?	Where are they now?
			M F	Y N
			M F	Y N
			M F	Y N

Have you ever given a pet away or taken a pet to a shelter? Yes No

If yes, what were the circumstances?

VETERINARIAN INFORMATION

Veterinarian's name and phone:

When was your current pet's last visit to a veterinarian and why?:

May we contact your vet as reference? Yes No

NEW PET INFORMATION

What are you considering feeding your cat?:

How often will you feed it?

Are you willing to spend $200-$500 for emergency veterinary care? Yes No

If you move, what do you plan to do with your pet(s)?

Who in the household will be the primary care giver?

Where will your cat be during the day? At night?

How many hours each day will the cat be unattended?

If behavior problems do present themselves at a later date, will you be committed to working with the animal to correct the problem? Yes No

What reasons would make you consider returning your adopted cat?

How did you first hear about this cat?
Adoption Day	Sarge website	Petfinder.com	Facebook
Mountaineer	Smoky Mountain News	Asheville Citizen-Times
Other
Comments:
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