Domestic Cat Rescue
W6387 County Road JJ
Appleton, WI 54913
Phone: (920) 757-6402
Fax: (920) 757-1121
Email: domesticcatrescue@yahoo.com
"Finding permanent loving homes since 1993"

Type of Pet Looking to Adopt: Date:

Pet's Name Pending Adoption: Pet's Description:

Last Name: First Name: Middle Name:

Address:

City: State: Zip:

Length of Time at This Address: If Less Than 2 Years List Previous Address Below:

Address:

City: State: Zip:

Email Address:

Phone Number(s); Home: Work: Cell:

Driver's License Number: Birthdate:

Employer's Name: Address:

Employer's Phone:

Names and Ages of All Children Under 18 Years-


Do you Rent or Own?

If Rent, Please Include Name and Phone Number of Landlord:

Name: Phone:

Names, Ages, and Type of all Pets in your Household:


What Veterinarian do you use?
City: Phone #

Personal References;
Name: Phone #

Name: Phone #


Any Additional Information that you would like to share;


If you rent, a copy of your lease and addendum for pets must be presented,matching the information above you have provided. The pet I am applying to adopt will be kept as an indoor pet, with the new owner providing vaccinations and health check ups by a qualified veterinarian on a yearly basis. I am applying to adopt this pet of my own free will. I certify that my answers are truthful and to the best of my knowledge. I further understand that any intentional misrepresentation will make this application null and void, and cause Domestic Cat Rescue to reclaim said pet because of my breach of contract , I will be held responsible for any associated legal costs incurred as part of said reclaimation process. Adopted pet are often rescued from different circumstances and need time to adjust to their new home. Your adoption fee is a donation to Domestic Cat Rescue and is NON REFUNDABLE after a period of 30 days. In order to ensure the best homes for our rescued pets, we reserve the right to deny any adoption application. I understand that I will be financially responsible for spaying/neutering a kitten or puppy that is under six months of age when adopted. Violation of this signed document will result in the reclaiming of animal. Domestic Cat Rescue/Little Squirt Grooming Inc. is not responsible for damage or injuries caused by adopted animal.

YOU MUST BRING A SECURE CAT CARRIER WITH WHEN PICKING UP YOUR NEW CAT/KITTEN!

Signed: Date:




PLEASE PRINT A COPY OF THIS APPLICATION FOR YOUR RECORDS !!!