Adoption Form - Medina Meow Fix

Medina Meow Fix

Cat Adoption Application Form

Adoption Form

Date *

Applicant Name *

Applicant Name

First

Last

Date of Birth *

Home Phone *

Cell Phone *

Work Phone

Email Address *

Address *

Address

City

State/Province

Zip/Postal

Best Way to Reach You *

Home Phone

Cell Phone (Call)

Cell Phone (Text)

Time Frame for Adoption *

Immediately

A Few Days

OtherOther

Work Status *

Employed Full-Time

Employed Part-Time

Self-Employed

Retired

Dependent on Guardian or Spouse

SSI/Disability

Student

Unemployed

OtherOther

Have you ever been personally responsible for a pet before *

Yes

I'm Interested In *

Cat

Kitten Over 6 Months

Kitten Under 6 Months

Which Animal(s) Are You Interested In *

Your Current Residence *

Apartment

House

Mobile Home

OtherOther

How Long Have You Lived Here *

Less than 1 year

1-3 years

3-6 years

6+ years

Do You Own or Rent Your Home *

Own

Rent

OtherOther

If you rent, we must confirm that you are allowed to have pets.

Owner, Landlord, or Leaseholder Name:

First

Last

Owner, Landlord, or Leaseholder Phone:

Is There a Fee to Have a Pet?

Yes

I don't know

Name(s) and Age(s) of Household Members (besides yourself)

How Would You Describe Your Household?

Busy

Quiet

OtherOther

Is Any Member of Your Household Allergic to Cats?

Yes

I don't know

Current Pets Living In Your Household

Name

Breed

Age

Spayed/Neutered

Name

Breed

Age

Spayed/Neutered

Name

Breed

Age

Spayed/Neutered

Name

Breed

Age

Spayed/Neutered

Name

Breed

Age

Spayed/Neutered

Are your pets up to date on their vaccinations? *

Yes

N/A

Are any of your cats declawed? *

Yes

N/A

Have you ever lost a pet due to an accident or illness? *

Yes

N/A

If Your Application is Approved:

What will you feed your cat? *

How often will you feed her/him? *

Once a day

Twice a day

As often as recommended

Anytime they ask

How often will you change her/his water? *

Daily

OtherOther

On average, how many hours per day would the new cat be left alone? *

Where will the cat spend its time? *

Where will the cat sleep? *

What places will be off limits? *

Are you financially able and willing to provide annual checkups, vaccinations, and necessary medical care? *

Yes

I don't know

Do you have a way to cover vet expenses in an emergency situation? *

Yes

How often do you anticipate taking your cat to the vet? Check all that apply. *

Yearly or as recommended

When necessary

In the event of an emergency

OtherOther

Will you let her/him outside? *

Yes

It depends

How do you feel about declawing? *

Have you ever lost (could not find) a pet? *

Yes

In the event that this cat gets lost, what steps would you take to find her/him? *

We understand unexpected circumstances may arise. Which of the following, if any, would cause you to give up your cat? Select all that apply *

Allergies

Allergies: Life Threatening

Marriage or Divorce

New Relationship

Pregnancy/New Baby

Moving

Child Lost Interest

Didn't "connect" with cat

Don't Have Enough Time

Illness or Death in Family

Litter Box Misuse/Aversion

Aggressive Behavior

Scratching Furniture

Conflict With Other Pets

Cat's Health

Too Expensive

Cat Got Too Big

Excessive Shedding

Cat Doesn't Like to be Held

None of the above

OtherOther

Have you ever given up or returned a pet for any reason? *

Yes

How long are you willing to allow the new cat to adjust? *

How will you introduce the new cat to current pets?

Do you have a room in your home where the cat can be kept isolated from current pets until it acclimates to your family and home? *

Yes

Please describe any arrangements you have made for your pets in the event of an emergency or change in your ability to care for them: *

Have you or anyone in your household ever been convicted of animal abuse or neglect, or are any such charges currently pending? *

Yes

Questions, concerns, or additional comments:

Two References:

Please provide two personal references who are not part of your household.

First Reference Name *

First Reference Name

First

Last

First Reference Phone *

First Reference Relationship *

Parent

Relative

Spouse

Friend

OtherOther

Second Reference Name *

Second Reference Name

First

Last

Second Reference Phone *

Second Reference Relationship *

Parent

Relative

Spouse

Friend

OtherOther

Veterinarian Info:

Veterinarian Name - Type N/A if not applicable *

Veterinarian Clinic/Hospital - Type N/A if not applicable *

Veterinarian Phone

How many years have you used this veterinarian?

Less than 1 year

1-3 years

3-6 years

6+ years

By signing this form, I acknowledge that all information on this form is true and correct. I understand that any misrepresentation of fact may result in denial of adoption privileges. If my request for adoption is approved and later Medina Meow Fix discovers the above information is not true, Medina Meow Fix reserves the right to remove the adopted cat(s) from my home.

Applicant Printed Name *

Applicant Printed Name

First

Last

Applicant Signature *

Clear

If you are human, leave this field blank.

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Medina Meow Fix

Cat Adoption Application Form

If you rent, we must confirm that you are allowed to have pets.

Current Pets Living In Your Household

If Your Application is Approved:

Two References:

Veterinarian Info:

Sign Up For Our Newsletter

Change a life today

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