First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Please list all individuals living in the household, including ages.

How would you describe the noise level in your home?*

Do you rent or own your home?*

If you rent, do you have permission from your landlord to have a cat?
Choose one: Yes No

Landlord's name and phone number.

How long have you lived at this address?*

Do you or anyone living in your home have any known problems with allergies or asthma to animals? If yes, please describe how this will be managed.*

Please explain where you envision your cat spending the majority of it's time while you are away.*

Do you have any behavior issues with your current cats? If yes, what measures are you taking to control those behaviors?*

Do you have a dog or cat door? Where does it lead?*

Where will the litter box for this cat be located? *

What breed, sex, and age of cat are you looking for?*

Why do you want to adopt a cat?*

Please check ALL cat behaviors you are unwilling or unable to deal with, tolerate, or work through until resolved.

Please describe the personality you are interested in (check all that apply):

I would like my cat to (check all that apply):

Which of the following do you plan to use (check all that apply):

If the cat you're interested in is NOT declawed do you plan to have him/her declawed?*
Choose one: Yes No Unsure

What would you do if this cat showed destructive behavior?*

How long do you think the adjustment period should take?*

What type/brand of food do you feed your cats and plan to feed this cat?*

How many hours a day will your cat be alone?*

How much do you expect to spend for annual medical care?*

Have you ever adopted a cat or dog before? If yes, from where?*

Have you ever had to surrender a cat or dog before? If so, for what reason and what provisions did you make for the animal?*

Total number of pets owned?*

Are all the pets in your household current on their medial care including vaccinations? If not, why?*

Have any pets in your household been diagnosed with infectious diseases or conditions? For example, FIV/FeLeuk, Distemper or Panleukopenia, or FIP*

Please list any living or deceased pets you have owned in the last 7 years:*

Please provide the name and contact information for the veterinarian that has cared for your animals of the last 7 years. If you have switched providers or use more than one please include information for all. *

Do we, Allie's Haven Animal Rescue, have your permission to contact the vet(s) you have provided?*
Choose one: Yes No

Does your veterinarian have permission to release medical information on any/all of your animals to Allie's Haven Animal Rescue for the purpose of evaluating this application for adoption?*
Choose one: Yes No

I hereby agree to hold Allie's Haven Animal Rescue and its Board of Directors, Volunteers, Foster homes and any and all entities and/or legal agents harmless from any injury, damages or losses directly or indirectly by any Allie's Haven Animal Rescue adoptable pets. Potential adopter and others release Allie's Haven Animal Rescue from any liability, claims, suits, obligations, demand or causes of action, known or unknown, foreseen or unforeseen arising out of any persons that come in contact with any Allie's Haven Animal Rescue pets.*
Choose one: Agree