Kitten/Cat Name: black line Description: black line

About You

Name:
First:black line Last:black line
Address:  black line
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City:
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State: black line
Zip: black line
Home phone: black line
Work phone: black line
Cell phone: black line
Email: black line
How long have you lived at this address? black line
What type is your residence?
House
Apartment
Condominium
Other
Do you
Rent
Own
Does your rental agreement allow pets?
Yes
No
Landlord's name:  black line Landlord's phone:  black line
How heavy is traffic on this street?
Light
Medium
Heavy
Do your windows have screens?
Yes
No
How many adults at this residence? black line How many children? black line Ages of children? black line
Does anyone in the home have allergies to cats?
Yes
No

About the Cat

Who is your veterinarian/veterinary clinic?
 Veterinarian: black line Phone: black line
Who will be primary caretaker for the cat(s)? black line
Who will take care of the cat(s) when you are away from home? black line
How often does the primary caretaker travel? black line
How many hours a day will the cat(s) be alone? black line
Where will the cat(s) be when alone? black line
Where will the cat(s) be when you are at home during the day? black line
Where will the cat(s) be when you are home at night? black line
The cat(s) will be
Indoor only
Outdoor only
Indoor/Outdoor
Do you anticipate declawing the cat(s)?
Yes
No

About Your Other Pets

What pets do you currently have? Please include their ages and how long you have had them.
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What pets have you had previously? Please include their ages and how long you had them.
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What happened to them?
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Have you ever had a declawed cat?
Yes
No
Have you ever surrendered one of your pets to a shelter?
Yes
No
  Please explain:
 
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Have you ever lost a pet or had one die of accident or injury?
Yes
No
Have you ever had a pet hit by a car?
Yes
No
Have you ever nursed a sick animal?
Yes
No
  Please describe the illness and the care provided.
 
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Notes

Is there anything else you'd like to tell us?
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Feedback

How did you find out about Community Cat Rescue? black line
Have you attended a Community Cat Rescue Adoption Fair?
Yes
No
Had you already decided to adopt a kitten/cat before attending the adoption fair?
Yes
No

Signature

I certify that the above information is true and understand that misrepresentations may result in the cancellation of the adoption.
Signature: black line
Date: black line