Membership Application Form

Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Number*

Area CodePhone Number
Cellular Number

Area CodePhone Number
Work Number

Area CodePhone Number
Age:*

Under 2121-3031-4041-5051-6061-70Over 70
List the ages of any children living in your home. If there are none, just type "none".*
List any adults with whom you share your home, and any pets they have living with them. If there are none, just type "none".*
Describe what type of cat you are seeking to adopt and why.
How long have you been thinking about adopting a cat?
List the pets that you currently have, indicating the type and age of each. If there are none, just type none.*
Have you ever owned any pets?*

YesNo
Do you have a plan for your pets in the event of your death, disability, or some other emergency situation?*

YesNo
Do you own or rent your home?*

OwnRent
Are pets allowed where you live?*

YesNo
Do you plan to declaw the cat?*

Yes, front pawsYes, all pawsNo
Where will the cat live?*

IndoorOutdoorIndoor/Outdoor
Where will the cat stay while you are away?*
Where will the cat be kept at night?*
What rules will you establish for the cat?
Have you previously adopted from another animal or rescue group?*

YesNo
Check any of the following reasons for which you would give away your cat:*

Doesn't use litter boxToo ExpensiveDamages furnitureNew babyGetting married or divorcedAllergiesNot good personalitySheds too muchFleasMovingNone
Are there any other reasons you would give your cat away?*
Does anyone in your family have allergies?*

YesNo
Does your employer have a matching donation program?*

YesNoDon't Know
Name of employer*
Would you agree for a Saving Graces 4 Felines volunteer to make a follow-up home visit or a telephone call after the adoption?*

YesNo
Veterinarian's name:*
Vet's phone number:*
May we contact for a reference?*

YesNo
Should be Empty: