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Name of Cat
Your Name:
Street Address:
City
State & Zipcode
Phone Number:
Best time to call you
Hours
01
02
03
04
05
06
07
08
09
10
11
12
AM
PM
Email:
Are you presently
Employed?
Retired?
A student?
Present Employer, if employed:
Number of People in Household
Are you or any member of the household allergic to cats?
No
Yes
Number of children in household under 7 yrs old
0
1
2
3
More than 3
Type of residence:
House
Apartment
Condo
Mobile Home
Farm/Barn
If rental, are cats allowed?
Yes
No
Manager/Landlord Name
Manager/Landlord Phone:
Do you live
Within city limits
Outside city limits
Where will cat live?
Inside only
Outside only
Mostly inside
Mostly outside
Where will cat spend nights?
Inside
Outside
Will you allow the cat to run loose outside?
Yes
No
Describe the activity level in your home:
Busy (visits by friends, children, parties at home
Noisy (TV/stereo, children playing, dogs barking)
Moderate (Normal comings & goings)
Quiet (homebodies, few guests)
Under what circumstances would you return the cat ot us?
I would not give up the cat. Adoption is forever.
New job
Divorce
New baby
Move
Illness
Behavorial issues with cat
Do you currently have pets?
Yes
No
If you currenlty have pets, are they all spay/neutered?
Yes
No
Name of your vet?
Personal reference name and phone (not a relative):