Pet Adoption Form Pet Adoption form Name * Name First First Last Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone * Email * Employer Occupation What type of pet are you looking for? Dog Cat What gender are you looking for? Male Female No Preference Type of cat Kitten Adult Long Hair Short Hair Do you understand that if you're adopting a cat, it may take a couple months to get used to your present companion animals? Yes No Name of pet you're interested in How many people currently reside in your household? Any children in the household? Yes No List Ages For whom are you adopting the pet? Self Gift Does any member of the family have any allergies to animals? Yes No If yes, explain Who will be responsible for the pet’s care? Where do you live? Apartment Condo Farm Mobile home Townhouse House OtherOther Do you own or rent your residence? Own Rent Landlord's Name Landlord's Phone Are companion animals allowed at your residence? Yes No Unsure Where will your pet spend most of their time? Indoors Outdoors Both In/Out When outdoors, the pet will be attended unattended Where will the dog spend most of his/her day when you are NOT home? Indoors Free Roaming Indoors In a crate Outdoor Kennel Outdoors-Fenced Yard Indoor/Outdoor Freedom (Doggie Door) Tell us about your yard I do not have a yard Backyard with no fence Backyard with a fence Do you have a dog/cat door? Yes No Will anyone be home during the day? Yes No How many hours will the pet be left unattended? If you move, what will you do with the pet? How far from the road/traffic is your residence located? Is the volume of traffic Light Moderate Heavy Have you ever had a companion animal before? Yes No Describe those companion animals you still care for or that are living in your household. Describe those companion animals you no longer care for Are your companion animals current on their vaccinations? Yes No What are your opinions on vaccinations? Name of veterinarian Phone Are you financially able and willing to provide annual checkups, vaccinations, and ANY medical care necessary? Yes No If you have a dog, is he/she permitted to run loose? Yes No What precautions would you take to properly introduce a new cat into your home if you have other animals (a dog, bird, rabbit, another cat, etc.)? What will you do if your new cat does not get along with your present companion animals? Are you planning on declawing? Yes No Unsure Have you ever adopted an animal from a rescue/animal control agency? Yes No Have you ever had an application rejected for adoption of an animal from a rescue/animal control facility? Yes No Explain the situation Why do you want to adopt a pet? If a disciplinary or behavior problem arises, what steps will you take to work on it? Are you familiar with your local animal control laws? Yes No Are you willing to sign legal pet adoption papers? Yes No Do you agree to permit a visit to your residence by appointment? Yes No By signing this form, I/we acknowledge that all information on this form is true and correct. I/we understand that any misrepresentation of fact may result in Cheyla’s Rescue Foundation refusing adoption privileges to me/us. If my/our request for adoption is approved and later Cheyla’s Rescue Foundation discovers the above information is not true or correct, Cheyla’s Rescue Foundation reserves the right to remove the adopted cat from my residence and retake ownership of the pet. Signature * signature keyboard Clear Date * Captcha Submit If you are human, leave this field blank.
