Adoption Form

Name (include Maiden)

Phone

Date of Birth:

Address:

City:

State:

Zipcode:

County:

How long at this address?

Own or Rent?(required)

Own Rent

Is your name on the lease or title?(required)

Yes No

Landlord Name:

Landlord Phone # (please advise them we will call):

Previous Address (if less than 2 yrs. at present address):

Previous Landlord:

Previous Landlord Phone #:

Employer:

Work Phone #:

How long employed there?

Supervisor Reference:

Spouse/Partner (include maiden name):

Spouse/Partner Employer:

Work Phone #:

How long employed there?

Supervisor Reference:

Have you ever applied with us or another rescue?(required)

Yes No

If applicable, name of other rescue:

Veterinarian BUSINESS Name (Please advise vet we will be calling):

Your name as registered with Vet. (Not vet’s name):

Pet names (specify Dog or Cat):

Do you agree to a home visit?(required)

Yes No

Have you ever had a cat declawed? (required)

Yes No

If yes, why?

Who shares your home with you? (Name including maiden, relationship, and date-of-birth for each person):

Do you have anyone to take care of your pet should you no longer be able to
physically or financially?(required)

Yes No

List Name, Relationship and Phone Number of Person who can care for your pet:

If there are children in your home, please explain why you feel they will be responsible and treat pet respectfully:

Does anyone in your household have allergies you are aware of?

Do you have any plans to move in the near future?

How long will the pet be left alone daily?

Please enter the NAME, SEX and COLOR of the pet(s) you would like to adopt:

Pets are an investment of your time and money. Can you afford to provide MEDICAL CARE, grooming, and proper diet?(required)

Yes No

Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as long as 15 years or more? (required)

Yes No

Please tell us any other questions or concerns:

THE PROSPECTIVE CAREGIVER AGREES:

Your checkmark is your agreement/initial:(required)

Pets are to live in a private residence as companion animals This agreement DOES NOT allow the declawing of a cat. If the pet must be relinquished for any reason, you MAY NOT turn over to another shelter or person, but must return to us. The pet must be provided with sufficient quantities of food and water. The pet must never be struck or otherwise harmed. St. Cats & Dogs has visitation rights to ensure the terms of the adoption agreement are being observed. All vaccinations are to be kept current, and veterinary care provided in times of illness or injury. I understand that failure to perform the foregoing agreement will constitute a breach of contract. In the event of any such breach, I authorize St. Cats & Dogs to reclaim possession of adopted pets.

As of this day, to the best of our knowledge, the pet is in good health.

We reserve the right to refuse adoption to any applicant for any reason, i.e. incomplete or unanswered questions and/or false information may result in being denied. This questionnaire becomes part of our contract.

Electronic Signature:

Date:

St. Cats and Dogs of Nay Aug Zoo

Reducing the population of feral cats • Finding homes for friendlies

Adoption Form

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