Download the application in Word format
Name: ________________________________________ Driver's License #: __________________
Date: __________
Address: ______________________________________________________ City:
_____________________________
State: _________ Zip Code: ___________________ Email: _______________________________________________
Home Phone: __________________________ Cell: __________________________
Work: _____________________
Occupation: _________________________________ Employer: ___________________________________________
***
Why do you want to adopt this (these) cat(s) or kitten(s)? _________________________________________________
Would the kitten be Indoor/Outdoor/Both? _____What is the traffic like
on your street? _________________________
Do you live in an apartment or house? ______ Own? ____ Rent? ____ Does
landlord allow pets? ________________
Landlord's Name & Phone: _________________________________________________________________________
Please list the ages of children currently living in your home? ______________________________________________
Is anyone in your home allergic to cats: Yes ____ No ___ If yes, do they
take allergy medication? _________________
Please list all other pets currently living in your home: ____________________________________________________
Are your other pets current on their vaccinations? ______ Are they indoor/outdoor/both
(please specify which pets are
indoor/outdoor/both): ______________________________________________________________________________
Have you owned a cat previously? _______ What happened to this/these cat(s)?
_______________________________
Have you ever de-clawed an animal? ____________ Have you ever surrendered
an animal to a shelter? ____________
***
Veterinarian's Name (we may use as a reference): _______________________________________________________
Vet's Phone: ________________________________ Address: _____________________________________________
Personal Reference (Name & Phone): _________________________________________________________________
The stated information is both true and complete.
OFFICE USE ONLY:
Adopter: _____________________________________________ Foster Parent:
_______________________________________
Cat(s) Name(s): _________________________________________ and ______________________________________________
Microchip #: ____________________________________________ and _____________________________________________
HUMANIMAL CONNECTION RESERVES THE RIGHT NOT TO ADOPT A CAT OR KITTEN TO
ANYONE.
© 2008 Humanimal Connection, Inc.