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Cat name and shelter ID#:
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Your name:
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Current date and time:
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Home address (Street Name and Street Number):
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Home address (City, State, and Zip Code):
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Home phone:
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Cell phone:
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Email:
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Your employer:
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Name and age of all household residents:
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Who will be primarily responsible for the cat?:
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Do you live in A:
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Do you rent, own, or live with parents:
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If you are renting, WHat is your Landlord's Name And Phone:(If You Own Put N/A)
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Are you willing to work through behavioral problems with your new cat?:
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Will you give the cat 6 weeks to adjust to their new home?:
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Will you take the cat to the vet within 7 days of adoption?:
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Do you understand that your adopted animal may require vet care as a result of shelter related illness?:
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Have you ever had to give an animal away?:
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What were the circumstances?(If you never have put N/A)
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Will you be declawing your cat:
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I prefer a cat who will...(select all that apply)
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Live IndoorsLive OutdoorsCome and Go Independently
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I will not tolerate the following(Check all that apply)
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Not using a litterboxScratching furnitureWanting to go outsideplay bitingN/AOther(explain in additional comments)
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List current pets and any pets you have had in the past 5 years:
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Current/past 5 years pet breed, type, gender, age, spayed/neutered?:
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What is your veterinarians name and phone number?:
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What name are the vet record under?
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If current pets are not up to date on vaccines or altered, explain why(if they are put n/a)
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Provide an alternate contacts name and number
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Additional comments(explain here why you chose other)(if none put N/A)
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Sign And Date:
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