Name of cat(s) you're interested in
*
Your Name
*
Please list your name and your co-adopter's name
First Name
Last Name
Your mailing address
*
Your Telephone Number
*
Co-Adopter Name
First Name
Last Name
Co-Adopter Mailing Address
Co-Adopter's Email
Co-Adopter's Telephone Number
(###)
###
####
Driver's License and State - If not provided - this information will be required before final adoption.
How long have you lived in Arizona?
*
How long have your lived at your current address?
*
If less than 2 years, please list prior addresses for the past 5 years:
Annual Household Income
Three NON-Family References With Phone Number
*
Current Vet Name and Phone Number
How often do other children visit your home?
*
Is your home
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Apartment/Condo
Single Family Home
Apartment
Mobile Home
Do you
*
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Own
Rent
If renting, are you fully aware of all pet policies & prepared to pay all required pet deposits?
Please provide a description of the home your cat will be living in (single family, apartment, trailer, condo with large or small yard
Is anyone in the home ALLERGIC to Animals?
*
Is everyone in the household in agreement on adopting a new pet at this time?
*
Has anyone in the household been charged with domestic violance or animal abuse?
*
Please tell us about the pets you currently have at home:
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PLEASE INCLUDE THE FOLLOWING INFORMATION FOR EACH ANIMAL:
Animal Type
Spayed/Neutered
Microchipped
Up to Date on Shots
LIve Inside or Out
Still Alive
If deceased, reason and age:
If no longer living with you Reason why:
Male or Female
How long have you had them
If your animals are not Spay/Neutered please explain why:
*
Have you owned a cat in the past? If so, when and for how long?
Who will be the primary caregiver for this animal?
*
Reason(s) for wanting to adopt a pet at this time?
*
Please describe in your own words why you are interested in adopting a pet at this time.
*
Does your job require frequent travel?
Who will care for your pet if you go on vacation?
What is the activity level in your home?
*
If you currently own a cat(s) do they get along with other cats?
*
Have you lost a pet in the past 5 years?
*
If you have lost a pet, please check reason(s)
*
Have you relinquished an animal in the last 5 years?
*
Reason that you relinquished an animal in the past 5 years:
*
For which of these reasons would you give up a pet?
*
Where will the cat be when you are not at home
*
Do you plan on crating your animal when you are gone?
*
How long will your animal be alone during the day?
*
Will this animal live:
*
How much are you willing to spend a year on medical expenses for your cat?
*
If you had suddenly had to relocate, move, etc., what will happen to your pets?:
*
What type of behavior is unacceptable to your/your family?
How would you deal with this behavior?
Will you commit to this pet for its lifetime despite changes in your life?
*
Please Explain
I hereby agree that I will provide a copy of my drivers license, copy of rental agreement, HOA Bi-laws (Rules/Regulations) and/or copy of Lease Agreement, and agree to a home inspection if warranted and requested by the rescue. I further agree that my references will be contacted, and that all the information on this form is correct.
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First Name
Last Name
Date
*
MM
DD
YYYY
Co-adopter Name
First Name
Last Name
Date
MM
DD
YYYY
DISCLOSURE
