Name of cat/kitten applicant is applying for:
Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone | Home
*
(###)
###
####
Phone | Work
(###)
###
####
Phone | Cell
(###)
###
####
Email
*
Are you:
Living Arrangement
*If "other", where?
Do you:
If renting, please provide Landlord name and phone number:
How long have you lived at this address?
Do you anticipate moving in the future?
Number of adults:
Number of children and ages:
Do any members of the family have allergies that may be aggravated by the addition of this cat?
Who will mainly be responsible for the care of this cat?
Name, breed, age and sex:
Where did he/she stay during the day?
Where did he/she stay during the night?
Spayed/Neutered?
Last Vaccination Date:
MM
DD
YYYY
Is he/she still with you? - If yes, tell us a little bit about them. If they have passed on, please let us know what happened.
Name, breed, age and sex:
Where did he/she stay during the day?
Where did he/she stay during the night?
Spayed/Neutered?
Last Vaccination Date:
MM
DD
YYYY
Is he/she still with you? - If yes, tell us a little bit about them. If they have passed on, please let us know what happened.
Name, breed, age and sex:
Where did he/she stay during the day?
Where did he/she stay during the night?
Spayed/Neutered?
Last Vaccination date:
MM
DD
YYYY
Is he/she still with you? - If yes, tell us a little bit about them. If they have passed on, please let us know what happened.
Veterinarian Name:
Veterinarian Number:
(###)
###
####
Are you willing to accept the financial responsibility of owning a cat/kitten and all unexpected/required medical expenses?
How do you plan to correct unwanted behaviors? (ie. scratching furniture, chewing plants, getting on counters, etc.)
How do you plan to introduce your new pet to the others in the home?
Do you plan to let your cat outside?
Are you prepared to allow an adjustment period of at least one month?
Are you willing to work through any issues your new pet may have/develop?
If you have to move what do you plan to do with you pet?
If you go on vacation what do you plan to do with your pet?
Have you or any member of the household been charged with Animal Cruelty?
Have you ever had to surrender a pet? If yes what were the circumstances?
Most importantly, why do you wish to adopt this cat/kitten?
Reference 1 Name:
*
First Name
Last Name
Reference 1 Phone number:
*
(###)
###
####
Reference 1 email:
Reference 2 Name:
*
First Name
Last Name
Reference 2 Phone Number:
*
(###)
###
####
Reference 2 email:
Reference 3 Name:
First Name
Last Name
Reference 3 Phone Number:
(###)
###
####
Reference 3 email:
I agree to the following:
*
I understand that any information given will be held confidential.
If under any circumstances I am unable to keep this animal, I agree to return him/her directly back to the shelter. I understand no adoption fees will be refunded, and I may be charged a surrender fee.
The pet will not be abused, neglected, or mistreated in any manner and will not receive any cruel or inhumane forms of punishment.
The pet will not be chained, roped or otherwise tethered at any time.
The pet will not be caged/kenneled needlessly or for long periods of time.
The pet will not be trained or used for attack/bait and will NEVER be used for animal fighting or other illegal practices.
By checking below I certify that the information I have given is true and that by any misrepresentation of facts may result in losing the privilege of adopting. I understand that the Carleton County Animal Shelter has the right to deny my request to adopt an animal and I authorize the investigation of all statements in this application.
Date of Agreement
MM
DD
YYYY
