Adoption Application Form

If you are interested in adopting a cat or kitten through Miri's House, message us on Facebook or email mirishouse (at) to set up a visit with our foster cats. You can print out this adoption form and bring it with you, or you can send it by email. If you don't have a specific animal you want to adopt yet, or you want to be considered for fostering, you can fill out the form, and we will let you know when we have adoptable animals or fostering opportunities.
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? __________________________________________________________

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?



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), or message us here.