Please Tell Us a Little About You

Date:______

Please tell us a little about you:

Applicant’s Name:______Phone:______

Co-Applicant’s Name:______Email:______

Address:______

City:______State:______Zip Code:______

Please list everyone in your household (including children living at home and their ages):______

______

______

Please Provide one personal reference:______Phone:______

Do you rent or own?______

If renting please provide your landlords name and contact info:______

(we will check with your landlord regarding pet policies to ensure the cat is not displaced from the home.)

How many pets are you permitted to have?______Is there a security deposit required per pet?______

Sometimes a move is inevitable, have you considered how a move may affect your cat(s)? Would you consider moving to a rental property that doesn’t allow pets?______Please comment:______

______

Do you travel?______Are you responsible for military duty?______

If “yes” to either of these questions, who will provide for your animal(s) during your absence?

______

Please tell us a little about your pets:

Please list all current pets in your home:

Type Age Name Spayed/ Do they

or neutered go outside

______

______

______

______

______

Have you previously owned any pets?______If yes, please explain what happened to them:______

______

______

Have your cats at home been tested for:

Feline Leukemia (FELV) ? yes or noFeline Immunosuppressive Virus (FIV) ? yes or no

Are your cats at home current on their vaccinations? yes or no

Adoption & Care Considerations:

If your adopted cat should develop behavioral problems (scratching, not using the litter box, etc.), are you willing to work through the problems with your cat? yes or no

Do you expect any of your current pets to have trouble adjusting to a new cat in the house? yes or no

If yes, what measures will you take to help with the adjustment or if there is a problem?

______

Do you accept responsibility for ensuring all animals in your home see a vet at least yearly? yes or no

Who is your veterinarian?______Phone:______

Is it ok if we contact your veterinarian for a reference? yes or no

How much would you estimate your annual expenses for a cat to be?______

If your pet should become ill, can you afford veterinary expenses? yes or no

Who will be responsible for the daily care of the cat?______

Is anyone in your household allergic to cats? yes or no

Under what circumstances would you not keep your cat? (please check all that apply)

New Baby _____Your Illness _____Cat’s Illness _____New Job _____

Divorce _____Move _____New Pet in home _____

Cat’s Behavior _____ (please specify what behavior______)

Other:______Doesn’t Apply ______

Have you considered and/or made arrangements for the care of your pets in case you can no longer care for them?

______

Please tell us what type of cat you are looking for:

_____Companion for self/family _____Companion for pet _____Mouser_____Barn cat

_____For children _____As a giftOther:______

______

Clarion Paws use only:

_____ Landlord/housing verified by ______on ______

_____ Personal Reference verified by ______on______

_____ Vet reference verified by ______on______

APPROVED - cat adopted/date:______

DENIED – notes/reason:______