LIFELINE ANIMAL RESCUE Inc.

Adoption application form

Personal Information

Your Full Name: *
Your E-Mail: *
Name of the cat you would like to adopt: *
Your Address: *
Phone Number - Home phone: *
Phone Number - Cell:
Employed By:
Work Phone Number:
Why do you want this pet? * Companion
Gift
Mouser
Companion for other pet
Other, please explain
If Other
Number of people in the house: *
Number of children in the house: *
Ages of children: *
Type of Housing? * Apartment
Condo
Duplex
Single Family Home
Do you? * Rent
Own
If you Rent Please mention your landlord's Name and Phone number
Are pets allowed? * Yes
No
How long will the cat be left alone during the day? *
Where will the cat be kept while alone? *
Does anyone in your household have known allergies to animals?* Yes
No

Current Pet Information

Do you have pets now?* Yes
No
If Yes, mention NAMES, Types, Breeds and Ages of animals? Please list them individually (Eg: Angel, Cat - Russian Blue, 6yrs)
Neutered/Spayed? Yes
No
Declawed? Yes
No
Where are your pets kept? Indoor
Outdoor
Indoor/Outdoor
Have your current pets been around other cats before? Yes
No
If Yes, How do they react?

Past Pet Information

Did you have pets in the past? * Yes
No
If Yes, mention NAMES, types, Breeds, Ages of animals? Please list them individually (Eg: Angel, Cat - Russian Blue, 6yrs)
Please mention the cause/s of death
Neutered/Spayed? Yes
No
Declawed? Yes
No

Vet Information

Vet's Name: *
Vet's E-Mail: *
Vet's Address: *
Vet's Phone number: *

Additional Information

Do you plan to declaw the cat? * Yes
No
What will you do if the cat claws furniture or shows other destructive behavior? *
A cat can live 15-20 years. Are you financially prepared and willing to give this cat the medical care he/she requires for its lifetime? * Yes
No
Will you permit a volunteer to do follow-up calls and/or home visits for the purpose of assuring proper care and adjustment of the cat? * Yes
No