Second Chance Ranch Animal Shelter, Inc.

(SCRAS)

5/04/04

Adoption Application - Cat Date:______

The following information is requested so that we can assist you in the selection of a new pet. Our goal is to place animals in loving homes with compassionate people who will make lifelong commitments to them by accepting them as a member of their family. The adoption process is designed to help determine the best “match” between the pet and the lifestyle of the adopter. This also enables us to determine if the adoption is in the best interest of the animal.

In order to adopt an animal from SCRAS, you must:

·  Be 18 years of age or older

·  Have identification showing your present address

·  Have the consent of your landlord

·  Be able and willing to spend the time and money necessary to provide training, medical treatment, and proper care for a pet

Adopter’s Name:______

Address______

Phone Number: (Day and Evening) ______

Driver’s License/Identification______

How long have you been at this address?______

1.   How many people live in your household?

Adults _____Children______

Ages of children: ______

2.   Is anyone home during the day?______

3.   Is this your first experience owning a pet?______

4.   Do you currently own pets?______

Are they up to date on their vaccinations?______

Pet’s Name Breed Female/Male Altered Age Health Status

5.   Why do you want to adopt an animal?

6.   Where will this pet be primarily living?

7.   What type and age of pet are you interested in?

8.   In what type of dwelling do you live?______

9.   Where will you confine your new cat when he /she first comes home?______

10.   Where will you place the litter box? How many litter boxes do you plan to have? ______

11. How will you introduce your new cat/kitten to your present cat?______

12. How will you introduce your new cat/kitten to your dog?______

13.   Will you allow your cat/kitten to go outside? Where?______

14.   How many dogs and cats have you owned in the past five years? ______

______

15.   Please list each pet and the status of each pet you have owned in the past five years (if not currently living with you: ______

16.   References

Veterinarian (Name and phone #)______

______

Personal references (Name and phone#)______

______

______

Please return to: Jim Tirpok

Fax 301-733-5918

Mail to: Fallston Animal Rescue 2725 Fallston Rd, Fallston, MD 21047

Fax: 410-557-7331

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