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Cat Adoption Application

Adoption: Cat

1Applicant

2Family

3Home

4Care

5Preferences

Hidden
Default: Cat Adopter Status
First Name*
Last Name*
Age Range*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite | Apt or Unit Number
City*
State/Province*
ZIP*
Country*
Home Phone Number
Work Phone Number
Cell Phone Number*
Preferred Method of Contact
Employment & Schooling
Are You Employed?*
- Yes
- No
- Retired
Full or Part Time?*
Name of Employer
How Long Employed There?
Are You in School?*
- Yes
- No
Full or Part Time?*
How Did You Hear About Us?*
What Is Your Friend's Name?*
Which Shelter?*
Which Rescue?*
Please Describe*

Below are three areas for information on other members of your family. Please include all other adults, children and pets living in your home by clicking on the designated button.
Are There Other Adults In The Home?*
- Yes
- No
Add Adults
Configuration Required
Use the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field.
Are There Children In The Home?*
- Yes
- No
Add Children
Configuration Required
Use the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field.
Do You Now or Have You Ever Had a Cat?*
- Yes
- No
Have you ever taken care of a cat before (ie cat sitter, etc) or have any other cat experience?*
Please Describe*
Add Cats
Configuration Required
Use the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field.
Are There Other Pets In The Home?*
- Yes
- No
Add Pets
Configuration Required
Use the Nested Form and Summary Fields settings to choose the form and fields to display in this Nested Form field.

Residence
Type of Residence*
Please Describe Type of Residence*
Do You Own or Rent?*
Does Landlord Allow Cats?*
- Yes
- No
Please Provide Landlord's Name*
Please Provide Landlord's Phone Number*
Yard Information
Do You Have A Yard?*
- Yes
- No
Is The Yard Fenced?*
- Yes
- No
How High Is The Fence?*
What Is The Lowest Point of The Fence?*
What Material Is The Fence Made From?*
Please Describe Fence Material*
Is The Lawn Treated?
- Yes
- No
Do You Have A Pool?*
- Yes
- No
Is The Pool Completely Fenced?*
- Yes
- No

Family & History
What Type Of Household Do You Have?*
Please Describe*
Do All Family Members Want A Cat?*
- Yes
- No
Please Explain Who Doesn't and Why They Don't*
Is Any Member Of Your Household Allergic To Cats?*
- Yes
- No
Are You Willing To Take Responsibility For This Cat For The Next 15-20 Years?*
- Yes
- No
What Provisions Will You Make For The Cat Should You Become Unable To Care For Him/Her?*
Are You Capable of Providing Timely Healthcare?*
- Yes
- No
What Are You Willing/Able To Spend On Annual Vet Care?*
Please Explain Your Circumstances*
Feeding & Exercise
Who Will Be Responsible For Feeding The Cat?*
Sleep & Alone Time
Where Will The Cat Sleep?*
Where Will The Cat Be When Alone?*
Please Describe Where The Cat Will Be*
Do You Have A Doggie Door?*
- Yes
- No
Is It Locked When You Are Away From Home?*
- Yes
- No
What Is The Longest Time The Cat Will Be Alone (without humans)?*
Who Will Care For The Cat While You Are On Vacation?*
Please Explain Who Will Care For The Cat*
Behavior & Training
Cats Can Take A Month Or Longer To Adjust To A New Home, Particularly If Other Pets Are Involved. Are You WIlling To Devote This Much Time To Make The Cat Comfortable In Your Home?*
- Yes
- No
What Behaviors Can You Tolerate (and work on)?
Needs Social Skills*
- Yes
- No
Accidents In The House*
- Yes
- No
Inappropriate Chewing*
- Yes
- No
Excessive Scratching*
- Yes
- No
Separation Anxiety*
- Yes
- No
Other
- Yes
- No
Please Explain Other Behaviors You Cannot Tolerate*
Personal Reference
Please Provide A Personal Reference
Please Provide Reference's First Name*
Please Provide Reference's Last Name*
Please Provide Reference's Phone Number*
Please Provide Reference's eMail Address*
Relationship to Applicant*
Years Acquainted*
Veterinarian Information
Have You Used A Veterinarian Before?*
- Yes
- No
Please Provide Veterinarian's Name*
Please Provide Veterinarian's Phone Number*
Groomer Information
Have You Used A Groomer Before?
- Yes
- No
Please Provide Groomer's Name
Please Provide Groomer's Phone Number
Boarding Facility Information
Have You Used A Boarding Facility Before?
- Yes
- No
Please Provide Boarding Facility's Name
Please Provide Boarding Facility's Phone Number

Reason For Adoption
Select all that apply.
Family Companion*
- Yes
- No
Breeding*
- Yes
- No
Farm Cat | Mouser*
- Yes
- No
For Child*
- Yes
- No
Gift*
- Yes
- No
Companion For Current Cat*
- Yes
- No
Replace A Previous Cat*
- Yes
- No
Other
- Yes
- No
Please Describe Why You Want This Cat
Would You Consider:
Fostering While Waiting For The Perfect Cat?*
Two Cats?*
A Pregnant Cat?*
Bottle feeding Baby?*
A Cat That Can Be An Only Pet?*
A Cat That Is Afraid Of Small Children?*
A Cat That Needs Medications?*
A Cat That Has A Serious Health Condition?*
Please Select All Health Condition(s) You Would Accept*
A Cat that Has Special Needs?*
Please Select All Special Needs(s) You Would Accept*
Select All That Apply:
A Cat That is Litterbox Trained?*
Select Gender*
Select Age Range*
Select All That Apply
Select Personality*
Select All That Apply
Select Color*
Do You Have A Preferred Cat?*
Note: This does not guarantee this cat will be placed with you
List Other Cats You Are Interested In
When Will You Be Ready To Adopt?*
Is There Anything Else You Would Like to Let Us Know?
I am interested in receiving pet related services and products
- Yes
- No
Authorization
Authorization:*
All cats placed through the Daisy's Dane Sanctuary will have health checks, personality and temperament evaluations, and will be spayed or neutered prior to placement unless a medical condition exists, diagnosed by a veterinarian, that would prevent this surgery. I understand that this is a preliminary application and that there may be no Cat available in rescue at this time. I understand that if a Cat should become available, that I will be required to provide further information including, but not limited to, personal and veterinary references. I further understand that all information on my Preliminary Rescue Adoption Application will be kept confidential; that my application will be kept on file until I notify the Daisy's Dane Sanctuary that I am no longer interested in a rescue; and that I will not be contacted unless an appropriate Cat becomes available. I understand and agree *
- I agree
Email
This field is for validation purposes and should be left unchanged.

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