Adoption Application – Street Cat Rescue

Name *

First

Last

Age Range *

Email *

Email

Confirm Email

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone Number

Work Phone Number

Cell Phone Number *

Preferred Method of Contact *

Email
Home Phone Number
Work Phone Number
Cell Phone Number

Are You Employed ? *

Yes, I am full time employed
Yes, I am part time employed
No, I am not employed

Are you in school? *

Yes, I am part time in school
Yes, I am full time in school
No, I am not in school

How did you hear about us? *

If friend recommended, What is your friend's name?

If Shelter recommended, Which Shelter?

If Other Rescue, Which Rescue?

If Other, Please Describe

How many adults in the home? *

How many children in the home? *

Family Member 1 Name

First

Last

Family Member 1 Age Range

Relationship to you

Are they employed?

Employer Name

Family Member 2 Name

First

Last

Family Member 2 Age Range

Relationship to you

Are they employed?

Employer Name

Family Member 3 Name

First

Last

Family Member 3 Age Range

Relationship to you

Family Member 4 Name

First

Last

Relationship to you

Are they employed?

Employer Name

Family Member 5 Name

First

Last

Relationship to you

Are they employed?

Employer Name

Any other adults or children living in your home? Please state their first & last names and relationship to you. If employed, state their employer name. *

Previous Experience with Cats *

Are there any cats in the home? *

Yes
No

If yes, please state the names, age range, gender of all cats or say N/A if not applicable *

What is the status of your cat or cats? *

All of them are spayed or neutered
One or some of them are spayed or neutered
None of them are altered

If NOT ALTERED, please explain why not? *

Where do the Cat or Cats live? *

Where does your Cat or Cats sleep? *

How social are your Cat or Cats? *

Very social
Social
Somewhat Social
Not Social

If any of your Cats not social, please describe their behavior *

Have all your cats been declawed? *

Yes
No

If yes, did your vet do the declaw? *

Yes
No

Are all your cats up to date on vaccines? *

Yes
No

Is there any other information about your cat or cats you would like to add

Are there other pets at home ? *

Yes
No

If yes, please select the other types of pets at home *

Please list the names, gender, animal type, where do they sleep in home, and how social they are for all your pets (other than cats)

Are there smokers in the house? *

Yes
No

Do you own or rent your home? *

Own
Rent

If rent, does landlord allow cats? *

Yes
No
I own the home

Please provide Landlord's name and phone number. If you own your home say N/A *

Do you have a yard? *

Yes
No

If yes, is the yard fenced? *

Yes
No

How high is the fence? *

What is the lowest point of the fence *

What material is the fence made from? *

If Other, please describe the fence or say N/A for not applicable *

Do you have a lawn and is it treated *

I do not have a lawn
Yes, lawn is treated
No, lawn is not treated

Do you have a pool and is it fenced? *

No, don't have a pool
Yes, pool is completely fenced
No, pool is not completely fenced

What type of household do you have? *

Active, Noisy, A lot of people coming and going
Calm, Quiet, Seldom visitors or people coming and going
Other

If Other, please describe the fence or say N/A for not applicable *

Do all family members want a cat? *

Yes
No

If NO, please explain who doesn't and why they don't or say N/A for not applicable *

Have you had a cat before? *

Yes
No

If yes, which breed? *

Where did you your cat? *

If yes, how long did you own him/her? *

If Other, please describe or say N/A for not applicable *

If yes, was the cat spayed or neutered? *

Yes
No
No, I did not own a cat

If yes, was the cat vaccinated annually? *

Yes
No
No, I did not own a cat

If yes, was the cat on heartworm prevention? *

Yes
No
No, I did not own a cat

If yes, please list the year range owned or say N/A for not applicable *

Please list and describe the year range and similar healthcare status as above for additional pets or say N/A if not applicable *

Have you ever had to give a cat away? *

Yes
No
No, I did not own a cat

If yes, please describe why you had to give the cat away or say N/A for not applicable *

Has it ever been necessary to euthanize a cat? *

Yes
No
No, I did not own a cat

If yes, please explain why you had to euthanize a cat or say N/A for not applicable *

Is any member of your household allergic to cats? *

Yes
No

Any smokers in the home? *

Yes
No

Are you willing to take responsibility for this cat for the next 15-20 years? *

Yes
No

What provisions will you make for the cat should you become unable to care for him/her? *

Are you capable of providing timely healthcare? *

Yes
No

If yes, what are you willing or able to spend on annual vet care? *

If you are unable to spend on annual vet care, please explain your circumstances or say N/A if not applicable *

Who will be responsible for feeding the cat? *

Applicant
Other Adult(s)
Children
Everyone

Where will the cat sleep? *

Where will the cat be when alone? *

If other please describe or say N/A if not applicable *

Do you have a doggie door? *

Yes
No

If yes, is it locked when you are away from home? *

Yes
No
No, don't have a doggie door

What is the longest time the cat will be alone (without humans) everyday? *

Who will care for the cat while you are on vacation? *

If other please explain who will care for the cat or say N/A if not applicable. *

Cats can take a month or longer to adjust to a new home, particularly if other pets are involved. Are you willing to devote this much time to make the cat comfortable in your home? *

Yes
No

What cat behaviors can you tolerate (and work on). Select all that apply. *

If other, please explain other behaviors you can and cannot tolerate *

Please provide a personal reference, provide full name, phone number, email address and phone number of the personal reference. *

Please provide relationship of personal reference to you and years acquainted. *

Have you used a veterinarian before? *

Yes
No

If yes, please provide veterinarian's full name and phone number or say N/A for not applicable *

What is your reason for adoption? *

If other, please describe the reason or say N/A for not applicable *

Would you consider volunteering at the cat ranch to find the purrfect match? *

Yes
No
Possibly

Would you consider adopting a cat that can be an only pet? *

Yes
No
Possibly

Would you consider adopting a cat that need medications? *

Yes
No
Possibly

Would you consider adopting a cat that has serious health condition(s)? *

Yes
No
Possibly

If yes, please select all health condition(s) you would accept *

Would you consider adopting a cat that has special needs? *

Yes
No
Possibly

If yes, please select all special need(s) you would accept *

Would you consider adopting a cat that is not litterbox trained? *

Yes
No
Possibly

Select gender of the cat you would like to adopt *

No Preference
Female
Male

Select age range of the cat you would like to adopt *

Do you have a preferred cat you would like to adopt? Please state color, cat energy level, breed preference, any information that would help us match you with your purrfect cat.

When will you be ready to adopt? *

Is there anything else you would like to let us know? *

All cats placed through the Street Cat Rescue will have health checks, personality and temperament evaluations, and will be spayed or neutered prior to placement unless a medical condition exists, diagnosed by a veterinarian, that would prevent this surgery. I understand that this is a preliminary application and that there may be no Cat available in rescue at this time. I understand that if a Cat should become available, that I will be required to provide further information including, but not limited to, personal and veterinary references. I further understand that all information on my Preliminary Rescue Adoption Application will be kept confidential; that my application will be kept on file until I notify the Street Cat Rescue that I am no longer interested in a rescue; and that I will not be contacted unless an appropriate Cat becomes available. I understand and agree. *

Yes

Phone

Custom Captcha *

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