First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

We do perform home safety checks, for that reason we only adopt out to people living in Ventura County or Santa Barbara County.

Are you employed? If so please provide name and phone number of employer.*

How did you hear about us*

Why are you interested in adopting a pet at this time*

How long have you been looking for a cat?*

Which animal are you interested in
Choose an animal: Abby Benji Cory Delbert Fozzy Bear Kiwi Pixie Polo Sister

Why do you want to adopt a cat?

How many people reside in your household*

How many adults in household?*

How many children in the household and what are their ages?*

Is there anyone in the household that is allergic to animals?

Do you own or rent your home*
Choose one: Rent Own

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

How long have you lived at this address?*

If you rent, have you received the approval of your landlord to have an animal*
Choose one: Yes No

If you rent, please enter your landlord's name and phone number*

Do you have a balcony?

Do you have a pet door?

Do you have any windows that don't have screens on them?

Will the animal be kept indoor or outdoor or both?*
Choose one: Indoor Outdoor Indoor/Outdoor

Where will the cat sleep?*

Where will you keep the litter box?*

Are you planning to declaw?*
Choose one: Yes No

Have you ever given up a pet? If yes, please explain*

What will happen to your cat when you go away on vacation?*

If you move will you take the cat with you? What happens if the place you move doesn't allow pets?*

How much time will the cat spend alone during the day*

What would you do with your cat if it becomes destructive.*

Who in the household will care for the cat*

Please list animals you have or had - included: Type of pet How obtained How long kept What happen to the pet*

Are your pets neutered/spayed?

Are your pets vaccinated?

Veterinarian's Name and Phone Number*

How much are you willing to spent on medical bills for your cat?

How long do you plan to provide a home for this cat?*

Are you willing to take responsibility for this cat for the next 10 to 20 years?

List at least one reference (who is not a family member) and their phone number*

May our organization conduct a safety check on you home?

I certify that the information entered on this applicant is true. Any false information may result in the nullification of this adoption. Enter your name and date*