Miri’s House
Cat & Kitten Rescue
Cat Adoption
Application Form
Contact Information
Full name: _______________________________________________________________
Address: _______________________________________________________________
Daytime Phone:
____________________________________________________________
Evening Phone:
___________________________________________________________
Best time to call:
___________________________________________________________
Email address: ___________________________________________________________
About the Cat(s) You
Wish to Adopt
Name of cat(s) or
kitten(s):
________________________________________
Desired age
(kitten or adult): __________ Desired Size:
_________________________
Desired breed:
_______________________________________________________________
Desired sex: Spayed Female ____ Neutered Male ____ No
preference____
Who will have
primary responsibility for this cat’s daily care? ________________________
Do you agree to
provide regular health care by a Licensed Veterinarian? ___ Yes
___ No
Do you agree to
contact us if you can no longer keep this cat?
___Yes ___No
How did you hear
about us? _____________________________________________________
Would you be
interested in fostering? ___Yes ___No
___Would like to know more
Family & Housing
How many adults are there in
your family? ______________________________________
How many children (ages)? ___________________________________________________
Do you ___own or ____rent
your home?
If you rent, please note any
rules governing pets and give your landlord’s name and number. (Please let your
landlord know we will be calling to confirm.)
_________________________________________________________________________
Please describe your
household: ___
Active ___ Noisy ___ Quiet
___ Average
Does anyone in the family
have a known allergy to cats?
__________________________
Is everyone in agreement with
the decision to adopt a cat?
__________________________
Do you have time to provide
adequate love and attention?
__________________________
If you had to move, what
plans do you have in place for your pet(s)?
__________________
__________________________________________________________________________
Do you have a pet sitter or other caregiver who could care for your pet(s) if had to be away overnight or longer? __________________________________________________________
Do you have a pet sitter or other caregiver who could care for your pet(s) if had to be away overnight or longer? __________________________________________________________
Other Pets
What other pets do you have?
_________________________________________________
Are these pets up to date on
vaccines? ___________________________________________
Are these pets
spayed/neutered? ____If not, why?___________________________________
If you have other pets, do
you have a room that can be closed off to keep the animals separated during the
introduction process? ________________________________________________
Have you ever surrendered a
pet? If so, why?
___________________________________________________________________________
Have you ever had a pet
euthanized? If so, why?
___________________________________________________________________________
Veterinarian
Do you have a regular
veterinarian? ___ Yes ___ No
_
Veterinarian’s name:
________________________________________________________
Clinic Address/Phone
________________________________________________________
(Providing us with this
information you are allowing us to call your vet. Please call your vet and ask them to
authorize the release of information to us.)
Personal References
Please list
someone who is familiar with both you and your pets.
Name:
_________________________________________-
Address:
________________________________________
Phone and/or
email: ____________________________________________
Relationship
(relative, neighbor, friend, etc.): ________________________
All of the information
I have given is true and complete. This cat will reside in my home as a pet. I
will provide it with quality cat food, plenty of fresh water, indoor shelter,
affection, and medical care and vaccinations under the supervision of a licensed
veterinarian. I agree not to sell or give away the animal, but to contact
Miri’s House Cat & Kitten Rescue if, for any reason, I can no longer keep
the cat.
___________________________________ ________________
(Signature) (Date)
Miri’s House Cat & Kitten Rescue
Somerset, MA 02725
President: Kathryn
Kulpa
Vice President:
Mary Callahan
Treasurer: Norman
John Larsen
Consultant: Lori
Bradley
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Send questions, adoption requests, or feedback to mirishouse (at) gmail.com, or message us here.