Online Application – Keeping Cats Homed

First Name*

Last Name*

Address*

City, Province*

Postal Code*

Phone Number*

Alternate Phone Number*

Email Address*

Alternate Email Address*

Employer*

Occupation*

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How many other people currently reside in your household?*

First person's name:*

First person's age:*

First person's relationship to you:*

Second person's name:*

Second person's age:*

Second person's relationship to you:*

Third person's name:*

Third person's age:*

Third person's relationship to you:*

For whom are you adopting the cat?*

Self

Other

If other, please explain*

Does any member of the family have any allergies to animals?*

Yes

No

Please explain*

Who will be responsible for the cat's care?*

Do you own or rent your residence?*

Own

Rent

Full name of landlord:*

Phone number of landlord:*

Are pets allowed?*

Yes

No

Unsure

If your rental agreement or lease does not allow pets, or does not specify if pets are allowed, please discuss your intention to adopt with your landlord prior to submitting this application.

Where will the cat be kept?*

Indoors only

Outdoors only

Both in/out

If outdoors, will the cat be*

Attended

Unattended

What identification methods do you plan to use? Choose all that apply.*

Collar and tags

Microchip

Tattoo

None

How far from the road/traffic is your home/farm located?*

Is the volume of traffic*

Light

Moderate

Heavy

If you move, what will you do with the cat?*

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How many pets have you had in the last 10 years that are no longer in your care?*

What was the first pet's name?*

What type of animal was the first pet?*

How old was the first pet when it left your care?*

Was the first pet neutered/spayed?*

Yes

No

Where was the first pet kept?*

How long was the first pet in your care?*

Why is the first pet no longer with you?*

What was the second pet's name?*

What type of animal was the second pet*

How old was the second pet when it left your care?*

Was the second pet neutered/spayed?*

Yes

No

Where was the second pet kept?*

How long was the second pet in your care?*

Why is the second pet no longer with you?*

Please enter notes about additional pets that are no longer with you below:*

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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

Please explain why your application was rejected (or N/A)*

Why do you want to adopt a cat?*

If a disciplinary or behavior problem arises, what steps will you take to work on it?*

Are you willing to sign legal pet adoption papers? *

Yes

No

Do you agree to permit a visit to your home/farm by appointment?*

Yes

No

I agree that I am 18 years or older*

Yes

How did you hear about Keeping Cats Homed?*

Any additional comments?*

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 Keeping Cats Homed refusing adoption privileges to me/us. If my/our request for adoption is approved and later Keeping Cats Homed discovers the above information is not true or correct, Keeping Cats Homed reserves the right to remove the adopted cat from my home/farm.

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Signature*

Date*

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