Adoption Questionnaire

Cat/Kitten Pre-Adoption Application
Name of specific animal you're interested in (if any):
Home Environment:
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Phone Number *

Area Code Phone Number
Alternate Phone Number

Area Code Phone Number
What is the best time to call you?
Are you at least 21 years of age? *

Yes No
Residence *

House, own House, rent Apartment Live with parents Dorm or other on-campus housing
How long have you lived at at this residence? *
How many adults in household? *
How many children? *

List ages of children

	Age
1.
2.
3.
4.
5.

Is anyone in your home allergic to cats? *

Yes No

Please tell us about the animals you have now.

	Name	Species	Breed (Dog)	Male or Female?	Spayed or Neutered?	Age	Notes:
1.
2.
3.
4.
5.
6.

Are dogs up to date on rabies vaccine?

Yes No Not applicable
Are current cats declawed?

Yes No Not applicable
Animal Care:
Have you previously owned a cat/kitten? *

Yes No
If yes, how long did you have the cat(s)?
What became of the cat(s)? Please be specific.
How long has it been since you owned a cat?
Have you ever rehomed or relinquished a pet to a shelter or rescue? *

No Yes
If yes, please tell us about that experience.
Please list reasons why you would give up a cat/kitten *
Where will this cat live? *

Strictly Indoors Indoor/Outdoor Outdoors
Do you plan to declaw this cat? *

Front Only All Four Unsure No I will not declaw
Are you looking for a

Kitten 12 weeks to 6 months Kitten 6 months to one year Cat 1 year or older Senior cat 8 years or older No preference
Any other comments or preferences
Name of your veterinarian (s) Please list all vet clinics your current or most recently owned pets have been to:
Phone number of your veterinarian:

Area Code Phone Number
Phone number of your veterinarian:

Area Code Phone Number
Phone number of your veterinarian:

Area Code Phone Number
If your pet's vet records are under a different last name, please list here
Are you planning to visit an adoption event you saw advertised?

Yes No
If yes, on what date are you planning to attend?
The adult cats at our private shelter in Marengo, IL can be met by appointment. If you would like an appointment to meet adult cats what days and times of day are you available?
Where did you find out about ASAP? *
I have read the above form and agree to comply with the above as stated with the understanding my veterinarian references will be checked. *

Yes No
That's it! You've reached the end!
Should be Empty:

Cat/Kitten Pre-Adoption Application

Home Environment:

Animal Care:

That's it! You've reached the end!