The Cat House Adoption Form

The Cat House


Full Legal Name:	First: Last:
Applicant Date of Birth
Address
City	State Zip
Email Address
How Long?	I Own I Rent
Home Phone	Work Phone
I live in a:	house duplex apartment condo mobile home other
	(please specify "other")
If you live in a rental property, please provide:
Landlord Name
Landlord Phone Number:
If less than one year at present address, please provide previous address:
Address
City	State Zip
	I owned my home. I rented
Employer
Occupation

Is this pet for yourself?	Yes	No	If "No", who is the cat for?
Are you over 18 years of age?	Yes	No	If under 18, parent/guardian:
Are you a student?	Yes	No

List name and date of birth for all household members:
	Name Date of Birth (mmddyyyy)

Does anyone in the household have allergies? Yes No

If "Yes", to what?

If you move, will you take this pet with you?
Yes Yes, if landlord allows No Not Sure

List all pets currently in your household, including roommate's pets:
Name/Type	Color/Breed	Age	Sex	Altered?	Other (declawed, FIV, etc)

Have you owned a pet in the last 5 years not listed above? Yes No

If "Yes", please explain:

Current vet or clinic name:
When was your pet's last visit?
Purpose of visit:

Are you interested in a cat kitten
Do you have a specific Cat House cat in mind?

Do you have a specific color, breed or gender in mind?

If the cat you listed has already been adopted, are you interested in adopting another cat?
Yes No

I want this cat to be a:

barn cat/mouser household companion gift companion for other pet

child's pet breeder other please explain below:

My pet would be:

exclusively indoors primarily indoors/outside occasionally during the day

indoors/outdoors as it wishes outdoors with shelter

other please explain below:

Have you turned in pets to our shelter before?
Yes No
Any other shelter?
Yes No
Have you adopted from The Cat House before?
Yes No
Have you adopted from any other shelter or pound?
Yes No
Have you applied to adopt from the Cat House before?
Yes No If yes, approximate date:
In a 24-hour day, my pet would be alone for:
less than 4 hours 4-8 hours 8-12 hours more then 12 hours
If more than 12 hours, explain:

Are you aware of your local ordinances in regards to cats? Yes No
Will this cat share a litter box? Yes No
How many litter boxes will be provided in your home?
Are you willing to add an additional litter box if needed? Yes No If "No", explain:
Cats can take a month, sometimes longer, to adjust to a new home, particularly if other pets are involved. Are you willing to devote this much time to helping a cat become comfortable in your home? Yes No
If adopting a kitten, who will be responsible for for the socialization and training needs of a kitten four months of age or under?

A cat's lifespan may reach or exceed 20 years. Are you prepared to provide a home for a cat for that length of time? Yes No
The annual cost of food, litter, supplies, and routine vet care for one cat may exceed $500; conditions may arise that increase veterinary care costs to a much higher amount. Are you financially prepared for the cost of caring for a cat? Yes No
Are you considering declawing this pet? Yes No
Would you be willing to allow a representative of The Cat House to visit your residence by appointment? Yes No
Have you, or any member of the household, ever been convicted of a felony, or animal-related misdemeanor or violation?
Yes No
If yes, please explain:

Where did you hear about The Cat House?

By checking this box you agree that you have read the following Cat House Policy:

The Cat House limits pet adoptions to within a 200 mile radius of Lincoln, NE. We do not ship animals nor do we do any type of long distance adoptions. We do not adopt to persons under 19 years of age. We require prospective adopters to meet both us and the animal, fill out an application and be interviewed. Adoptions are not done a first-come, first-served basis. Applicants are selected based upon the best match of the particular pet's temperament and needs. If an application is approved we may require a home check so we can ensure the animals safety. These pets are not for sale and the decision of where to place them is solely the responsibility of The Cat House. We reserve the right to refuse placement of our pets to any individual who does not meet our criteria. We also reserve the right to keep our reasons for refusal confidential within our organization. The welfare of our rescue animals is our top priority.

Each Cat House cat or kitten has been tested for Feline Leukemia, has received a vaccination against rabies and distemper/upper respiratory infections, is spayed or neutered, and has been seen by a vet and received a physical exam. The cost to adopt a cat is $90 - payable by cash or check (we cannot accept Credit or Debit Cards at this time).

By clicking the submit button below, I certify that I have answered all questions truthfully, and I understand if any intentional false statements have been given this application and any subsequent adoption may be voided.

Image Verification
	Please enter the text from the image [ Refresh Image ] [ What's This? ]