You must be at least 21 years of age or have the written consent of a parent or legal guardian in order to adopt a pet. Please fill out this questionnaire completely and accurately. It's purpose is to help us to make the best placement possible. The adoption process may take an hour or more, as you will be talking with our adoption counselors, meeting selected cats, reviewing the responsibilities of pet ownership and the terms of the adoption agreement. This is time well-invested because a happy, healthy cat may live 15-20 years, therefore, we ask for your patience and cooperation.

Name                                                                                                                  D.O.B                    

Name of Spouse/Roommate                                                                                                     

Phone (h)                                          (w)                                         Best time to call                             

Address                                                                                                                                                 

City                                                                           State                                    Zip Code                     

How long have you lived at the present address?                                     

Do you rent?       Landlord's name                                Landlord's phone number                                          

Where do you live? House          Condo/Apartment           Mobile Home        Student or Military Housing         

Does your apartment/condo association allow pets?         How much is the pet deposit? _____________

Employer                                                                                                                                             

Occupation                                                                                                                                             

Drivers License                                                                                                                                         

Are you a student?                 

Are you planning to move within the next six months?         If yes, where?                                                         

What are your plans for your pet(s) if you are moving?                                                                                     

Are all members of your household aware of your plans to adopt a cat?                     

Please list 2 local references

Name                                                                        Address                                                                           
Phone                                                 Time acquainted                       

Name                                                                        Address                                                                           
Phone                                                 Time acquainted                       

What pets do you currently have in your home? (please include small caged animals). Use additional paper if necessary.

Who is your veterinarian?                                                                                                                                   

Name of veterinary clinic                                                                                                                                 

How long have you been a client?                                                             

If no pets at this time, have you had pets in the last 5 years?_______ 
What happened to them?                                                                                                                              

Have you adopted an animal from another shelter?        At any time, has a shelter turned down your adoption request?         Shelter name:                                                                         
Reason for denial:                                                                                                                                                      

Has your cat(s) been tested for the Feline Leukemia and Feline Aids viruses?           results: ____________ If your cat has not been tested, why not?                                                                                                  

Do you plan on declawing your new cat?        If yes, do you plan on declawing all 4 paws?      

Where will your new cat be kept? Indoors        Outdoors        Both      

How long will your new cat be alone during a 24 hour period?               hours

Are you able to pay an average of $85.00 per year in basic veterinary maintenance?_____

Should your cat become ill or injured, are you willing to pay at least $100 to $300 in medical costs?       

What is your main reason for wanting a cat today?