Adoption Application
(Please print and mail or fax to the number listed below)
Full Name: ___________________________________________________
Full Address:
_________________________________________________
Phone (day): _________________
Phone (evening): ___________________
Email:
_________________________________
Best time to be reached: _____________ Best method: _________________
Do you plan to breed? ______
Declaw? ______
Do you… Rent ______ Own
______
Are you planning on moving in
the next year? If yes, what will you do with your
cat?_______________________________________________________________
Where will this cat be kept (day/night)? _______________________________
How many hours a day will the
cat be without human companionship? ________
If you were out of town who
would care for this cat? ____________________
Do you have children?
__________ If yes, ages:_______________________
Would this be your
children’s first experience with a cat? _________________
Does anyone in your household
suffer from allergies? ____________________
Do you have other animals?
______ If yes, please list: ___________________
____________________________________________________________________________________________________________________________________
Have you ever surrendered an
animal to a shelter? If so, please explain the
circumstances:________________________________________________________________________________________________________________________
Have you ever had an animal
euthanized? If so, please explain: _____________
__________________________________________________________________
Why do you want to adopt a
cat?
___________________________________________________________________________________________________________________________________________________________________________
Do you understand that this cat needs an annual vet visit? _________________
Who will be responsible for the care and cost of this cat? __________________
Will you allow the cat to go
outside? Why or why not: ____________________
__________________________________________________________________
Are you over eighteen years of
age? ______ If not, a parent/guardian will have to
By signing below you agree that all
information on this application is true and
Signature:
_____________________________ Date: ____/____/____
Please note that you will be contacted
within 7 days to discuss your application.
Action For Animals In Distress Society
Unit 652, 141-6200 McKay Ave
Burnaby, BC V5H 4M9
Fax:
604 431 7652
http://www.actionforanimals.net
Staff Use:
Date received:
_____/_____/______
Declined: ______
Accepted: ______
Reasons/comments:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________