Email Application submission for: Name of Feline * How did you hear about Cat Around Town Project? * Make a selection Adopt-A-Pet Cat Cafe Facebook Kitty Yoga Local Shelter Pet Curious Website Petfinder Website PetSense PetSmart - Ft Jackson Blvd PetSmart - Two Notch Rd Previous CAT Adopter Other Referral If Other or Referral, provide details/name here: Contact Information: Applicant Name * Driver's License # * Co-Applicant Name Driver's License # Relationship to Co-Applicant If listed as significant other, how long together? Street Address * Mailing Address (if different) City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * County * Applicant Phone Number * Phone Type * Choose One Cell Home Work Applicant Email * Co-Applicant Phone Number Phone Type Choose One Cell Home Work Co-Applicant Email Preferred Method of Contact * Choose One Text Phone Call Email Family Information: How many adults in the household? * Ages * How many children in the household? * Ages * Are you willing to teach young children the proper care and treatment of this cat? * Yes No Is everyone in the home in agreement with adopting a cat? * Yes No Is anyone in your home allergic to cats? * Yes No Personal Reference: Name of Personal Reference (person not living in the household) * Relationship to Personal Reference * Contact Number for Personal Reference * Home Information: How long have you lived at your current address? * Home Status * Own Rent Please describe your home * House Apartment Townhouse Condo If you rent, please provide your Landlord's Name Landlord's Phone Number Do you have the permission of your landlord to have a cat? Yes No Is a pet deposit required? Yes No Has the deposit been paid? Yes No Current Pet Information: How many total pets do you have? * # of Cats * # of Dogs * # of Other * If you have dogs, what breed are they? Are all your pets spayed/neutered? Yes No Are your current pets on monthly flea preventative treatment? Yes No Are your current pets up to date on vaccinations? Yes No Do any of your pets have health issues that could affect a cat? Yes No If yes, please describe. Do your pets regularly see your veterinarian? * Yes No I don't have any pets Veterinarian's name * If no pets, type N/A Veterinarian's Phone Number Future Feline Information: Briefly tell us why you would like to adopt. My new cat will be: * Indoor only Indoor/Outdoor Outdoor only Are you considering declawing this cat? * Yes No Maybe Have you ever previously returned, re-homed, given away or sold any pets before? * Yes No If you answered yes, please explain the situation: Should something unexpectedly happen to you during your cat's life, who do you have designated to further care for your cat? * A home visit is required prior to approval of adopting a cat. Most can be completed virtually, however, if an in-home visit is required, will you permit a home visit by a Cat Around Town Representative? * Yes No By signing below, I/We certify that the above information is true and correct. I/We understand that Cat Around Town Project (CAT) has the right to deny any application. I/We authorize CAT to call the veterinary practice that is listed. Applicant Digital Signature (First & Last Name) * Date Signed * Co-Applicant Digital Signature (First & Last Name) Date Signed
