Mikes chance animal rescue .com

Cat(s) Name(s) *

Why do you want to adopt the cat? (Please select at least one box) *

Full name *

First

Last

Date of Birth *

Occupation *

Employer Name *

Spouse's/Partner's Name, Occupation, Employer Name

Street Address *

City*

How long at this address

Daytime Phone *

Nighttime Phone

Best time to call *

Email address *

Link to your social media profile (Facebook, LinkedIn, Instagram, ect.) *

How many adults are there in your family (their relationship to you)? (if none, write n/a) *

How many children (ages)? (if none, write n/a) *

What pets currently live with you (specify species, breed, and age) (if none, write n/a) *

Are these pets up to date on vaccines?

Yes
No

Housing *

Rent
Own
Live with parents

What type of home do you live in (single family house, townhome, apartment, condo, mobile home, etc.)? *

Do you have a yard? *

No
Fenced
Unfenced

How tall is your fence?

Are there any slats/openings that could allow a small animal to get in/out?

If you rent, please describe the rules governing pets and the landlord’s name and number

By providing this information you are allowing us to contact your landlord, please inform them of this call so they will speak with us

Please describe your household

Does anyone in the family have a known allergy to pets? *

Yes
No

Is everyone in agreement with the decision to adopt a pet? *

Yes
No

Do you have time to provide adequate love and attention? *

Yes
No

Who will have primary responsibility for this pet's daily care? *

Who will have financial responsibility for this pet? *

Have you ever had a pet (specify species, breed, age)? What happened to the pet(s) (deceased, lost, gave away, still have, etc.)? *

Were these pets spayed/neutered? If not, why?

Have you ever surrendered a pet? If so, why?

Have you ever had a pet euthanized? If so, why?

Have you ever lost a pet to an accident? If so, please explain.

Yes
No

Do you have a regular veterinarian?

Yes
No

Veterinarian’s name

Clinic name, address and phone number

providing us with this information you are allowing us to call your vet. Please call your vet and ask them to authorize the release of information.

Do you agree to provide regular health care by a Licensed Veterinarian? *

Yes
No

Personal Reference: Name, Phone#, email *

Do you plan on getting your cat(s) declawed? *

Yes
No

Where will the cat(s) spend the day? (describe) *

Where will the cat(s) spend the night? (describe) *

Number of hours (average) cat(s) will spend alone? *

While left alone, cat(s) will be: *

While left alone, pet(s) will be - Other (please explain):

What will you do with your cat(s) if you go on vacation? *

What will you do if your new cat(s) doesn't get along with your other pets? *

What will you do if your new cat(s) requires medical treatment exceeding your budget? What will you consider as unreasonable amount to treat a cat for disease or injury? *

Do you understand that sometimes a complete history and temperament of a rescue pet may not be known? *

Yes
No

How will you work on possible problems (scratching furniture, litter box issues, etc.) ? *

What do you consider acceptable reasons for giving up a pet? (check all that apply) *

Why do you feel that you and your family and this particular cat are a good match? *

Do you agree to contact us if you can no longer keep this cat? *

Yes
No

Will you be willing to let our representative visit your home by appointment? *

Yes
No

How did you hear about us? *

Agreement *

All of the information I have given is true and complete. This animal will reside in my home as a pet. I will provide it with quality pet food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.*