I. Personal Information
Animal's Name:
Your Name:
E-mail:
Address Line 1:
Home Phone:
Address Line 2:
Cell Phone:
City:
Occupation:
State:
Zip:
How did you hear about us?
I am over the age of 21
II. Household Information
Select One:
1. Type of Residence:
2. Residence Status:
If renting please provide your landlord's name and number:
3. Have you had cats previously?
4. Reasons for adopting:
5. Are you committed to giving an animal a loving home and proper care, including food, shelter, and regular veterinary care for its lifetime, which
maybe as long as 20 years?
6. Where will your cat live?
7. Do you intend to de-claw your cat?
If yes, please list below:
8. Do you now, or did you recently have other pets?
Currently in
home
Indoors/Outdoors/
Both
Species
 Current Shots
Breed
Spayed/Neutered
Name
 Age/Sex
De-clawed
9. How many hours a day will your pet be left alone?
10. Where will your pet sleep?
11. Have you lost a pet in the past 10 years?
If yes, what were the circumstances?
12. Under what circumstances would you consider giving up a pet?
13. Will you seek professional help if there are behavioral problems with your new pet?
14. Do you or any of your family members have allergies to cats?
15. What would happen to the cat if you were ill or incapacitated?
III.
References
1. Do you now, or did you in the recent past have a veterinarian?
If yes, please list name and phone number:
2. Please list names/numbers of two personal references:
IV. Terms, Signature and Release
I understand that cats require a vet visit at least once a year and I am comfortable with the possibility of additional medical expenses if my pet becomes
ill.
I understand that Feline Rescue Mission reserves the right to deny any application for any, or no, reason and Feline Rescue Mission may choose not to
reveal specific reasons.
I confirm that all the information provided above is true and complete and that any missing or incorrect information may delay the approval process.
I hereby grant permission for any veterinary offices listed above to speak to a Feline Rescue Mission member to discuss information related to my
ownership and care of current or previous pets.
Please be sure to contact your personal references and let them know that they will be receiving a call from Feline Rescue Mission. Thank you!