(Please note that if you have any technical problems with this form,
that you can click here to open a Word document version of this form. You can complete the form,
save it, and then send it as an attachment to firstname.lastname@example.org)
City: State: Zip:
Type (age, gender) and number of cat(s) you are interested
Name of cat(s) you are interested in:
Name and phone number of a reference who does not live
Please provide the name and phone number of your small
Please provide the name and phone number of your large
Do you agree to let Stray Cat Blues visit your home/farm
by appointment? Yes No.
Who will be responsible for the cat's care?
Do you own
or rent/board your
If you rent or board, please provide the name and phone
number of your landlord.
What is the size and description of your property?
How far from the road/traffic is your barn located?
Volume of traffic light moderate heavy
What is the speed limit?
Please describe those pets that are currently with you
(type, age, sex, altered status, how long owned).
If you have a dog, is it permitted to run loose? yes no
If yes, what provisions will you make to protect the cat(s)?
Please describe those pets that are no longer with you
(type, age, sex, altered status, how long owned)
What happened to the pets who are no longer with you?
Reason for wanting a cat?
Do you intend to declaw your cat(s)?Yes No.
Do you understand that barn cats adopted through Stray Cat
Blues must receive vaccinations as required by State law? Yes No.
15. How did you hear about Stray Cat Blues?
By submitting this form I authorize my veterinarian to
release to Stray Cat Blues, Inc. information about my veterinary
records of any and all animals I own or have owned. I also certify that
all the information in the application is true and correct and I
understand that false information may void the application. Approved
applicants will be contacted by a Stray Cat Blues, Inc. representative.