FIRST NAME: *

MIDDLE INITIAL: *

LAST NAME: *

DATE OF BIRTH: ... *

IS THERE A SPECIFIC ANIMAL YOU ARE INTERESTED IN?:

EMAIL ADDRESS:

HOME PHONE NUMBER:

CELL PHONE NUMBER:

ADDRESS:

LENGTH OF TIME YOU HAVE LIVED AT THIS ADDRESS: *

P.O. BOX:

CITY:

COUNTY:

STATE:

ZIP CODE:

PREVIOUS ADDRESS IF LESS THAN 5 YEARS: *

EMPLOYER:

WORK PHONE NUMBER:

IF YOU ARE UNEMPLOYED, WHAT IS YOUR SOURCE OF INCOME:

IF YOU ARE SELF-EMPLOYED, PLEASE STATE TYPE OF BUSINESS:

SPOUSE/PARTNERS full name:

SPOUSE/PARTNERS EMPLOYER:

S/P WORK PHONE:

DAYTIME PHONE WHERE YOU CAN BE REACHED:

PLEASE LIST ALL ANIMALS THAT CURRENTLY LIVE IN YOUR HOUSEHOLD. PLEASE INCLUDE ANIMALS NAME, AGE, TYPE OF ANIMAL AND SEX - IF NO CURRENT PETS, STATE NONE.: *

ARE THESE ANIMALS SPAYED OR NEUTERED?: *

PLEASE LIST PETS NAMES AND BREED OF ANY OTHER ANIMALS OWNED IN THE PAST THREE YEARS THAT ARE NO LONGER WITH YOU - IF NO PAST PETS, STATE NONE: *

WHICH VETERINARIAN/CLINIC HAVE YOU USED OVER THE PAST 5 YEARS?

CLINICS ADDRESS - STATE NONE IF YOU HAVE NOT USED A VET.:

CLINICS PHONE NUMBER - STATE NONE IF YOU HAVE NOT USED A VET.:

ARE THE ANIMALS YOU CURRENTLY OWN UP TO DATE ON THEIR VACCINATIONS?:

IF NOT, PLEASE EXPLAIN:

HAVE YOU ADOPTED A PET FROM A HUMANE SOCIETY OR RESCUE?: *

IF YES, NAME OF THE FACILITY: *

DOES ANY MEMBER OF YOUR HOUSEHOLD HAVE ALLERGIES TO ANIMALS?:

HAVE YOU OR ANY MEMBER OF THE HOUSEHOLD BEEN CONVICTED OF CRIMES AGAINST ANIMALS?: *

BARKING:

FENCE JUMPING:

CHEWING:

DIGGING:

HOUSE SOILING:

DO YOU PLAN TO LET YOUR CAT OUTDOORS?:

WHERE WILL YOUR CAT BE KEPT DURING THE DAY?:

AT NIGHT?:

WHAT TYPE OF ID WILL YOUR CAT WEAR?:

ARE YOU FAMILIAR WITH COMMON CAT BEHAVIORS SUCH AS: JUMPING ON COUNTERS/FURNITURE, CHEWING ON PLANTS OR SCRATCHING?:

ARE ANY OF THESE BEHAVIORS MENTIONED A CONCERN FOR YOU?:

PLEASE COMMENT:

DO YOU INTEND TO DE-CLAW?:

IF YES, DO YOU UNDERSTAND THE PROCEDURE INVOLVED WHEN DE-CLAWING?:

IF YES, VERY BRIEFLY EXPLAIN WHAT IS DONE IN A DE-CLAW PROCEDURE:

ARE YOU INTERESTED IN INFORMATION TO ALTERNATIVES TO DE-CLAWING?:

ARE YOU FAMILIAR WITH THE TRAITS OF BREED AND NEEDS OF THE CAT YOU ARE CONSIDERING?:

CATS LIVE LONGER THAN 15 YEARS. ARE YOU PREPARED TO TAKE RESPONSIBILITY FOR THE CATS ENTIRE LIFE?: