Embedded Files
Your name:
Spouse/roommate's name:
Today's date:
Home phone:
Work phone:
Cell phone:
Best time to call:
E-mail:
Address:
City:
State:
Zip:
How long have you lived at the present address?
Do you rent? If so, please provide your Landlord's name and phone number:
Do you live in a house/condo/apartment/mobile home/student housing/military housing?
Does your apartment/housing allow pets?
If so, how much is the pet deposit?
What are your apartment/housing policy pet rules? (ie. do they require neuter/spay, declaw, outdoor/indoor, etc)
Employer:
Occupation:
Are you a student?
Are you planning to move within the next six months? If so, where?
What are your plans for your pet(s) if you are moving?
How many adults are in your household?
How many children?
Is anyone in your household allergic to cats?
Are all members of your household aware of your plans to adopt a cat?
Does any member of your household have a marked dislike of cats?
Please list all pets currently in your home, including the type of pet, age, sex, whether they're altered and/or declawed, where they're kept, and how long you've owned them.
Please provide the name of your present and past veterinarians/clinics you see (as well as any roommates that have pets) and their contact info. Please include both the owner's name and the pet's names:
How long have you been a client of this clinic?
If you have no pets at this time, have you had pets in the last 5 years? If so, what happened to them?
Have you adopted an animal from another shelter?
Do you currently have an application with any other shelter or rescue group to adopt an animal?
At any time, has a shelter turned down your adoption request? If yes, please provide the shelter name and the reason for denial.
If you have pets, are their vaccinations current? Please list vaccination dates (month and year) for the following:
FVRCP: Rabies: Feline Leukemia:
Has your cat(s) been tested for Feline Leukemia and Feline Aids Virus? If so, what were the results? If no, why not?
Where will your new cat be kept? (Indoors, outdoors, both)
How long will your new cat be alone during a 24 hour period?
Have you considered where your cat will eat, sleep, use the litterbox?
Who will be in charge of daily care such as cleaning the litterbox, play time, and brushing?
Are you able to pay an average of $150 per year in basic veterinary care?
Should your cat become ill or injured, are you willing to pay $100 to $300 in medical costs?
What is your main reason for wanting a cat?
Internal use only
RCHS tag number:
RCHS representative comments:
RCHS representative who talked to you:
Page updated
Report abuse