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ONLINE CAT ADOPTION APPLICATION
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Indicates required field
First Name, Last Name
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First
Last
[object Object]
Home Phone Number
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Cell Phone Number
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Email
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Name of 1st Choice Cat
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Name if 2nd Choice Cat
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Name of 3rd Choice Cat
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ABOUT YOUR HOME
Type of Home
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House
Apartment
Mobile Home
Dormitory
Other
Do you?
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Own
Rent
Live with Parents
Live in School
Other
How long have you lived at this address?
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How many times have you moved in the past 5 years?
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Landlord Name (If Applicable)
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Landlord Phone No.
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ABOUT YOUR FAMILY
How many adults live in your house?
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How many children live in your house?
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Ages of children in the house
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How many children visit often
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Ages of children who visit:
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If none type 0 or none.
Are all household members in agreement with the adoption
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Yes
No
Does anyone have asthma or allergies to cats?
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Yes
No
Is anyone nervous or unsure around cats?
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Yes
No
Who will be the primary caregiver for the cat?
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Describe your household activity level.
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Do you currently have pets living with you?
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Yes
No
CURRENT PETS
Pet's Name
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Species/Breed
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Age
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Years Owned
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Gender
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Intact Male
Intact Female
Neutered Male
Spayed Female
Up-to-Date on vaccines?
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Yes
No
Pet's Name
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Species/Breed
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Age
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Years Owned
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Gender
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Intact Maled
Intact Female
Neutered Male
Spayed Female
Up-to-Date on vaccines?
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Yes
No
Pet's Name
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Species/Breed
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Age
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Years Owned
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Gender
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Intact Male
Intact Female
Neutered Male
Spayed Female
Up-to-Date on Vaccines?
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Yes
No
Do your current pets get along with cats?
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Yes
No
Do any of your pets have health or behavioral issues?
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Yes
No
Please explain any medical/behavioral conditions.
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What veterinary Hospital do you use?
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May we contact your vet to verify your pet's medical records?
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Yes
No
PET HISTORY
Do you & your family have experience owning cats?
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Yes
No
Do you have experience being the primary caregiver?
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Yes
No
Have you ever surrendered, given away or returned an animal?
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Yes
No
Have any of your pets ever had a litter?
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Yes
No
PREVIOUS PETS
Name
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Species/Breed
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Spayed/Neutered?
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Yes
No
Years Owned
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What happened to them?
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Vet Used
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Name
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Species/Breed
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Spayed/Neutered
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Yes
No
Years Owned
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What happened to them?
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Vet Used
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Name
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Species/Breed
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Spayed/Neutered?
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Yes
No
Years Owned
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What happened to them?
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Vet Used
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Name
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Species/Breed
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Spayed/Neutered?
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Yes
No
Years Owned?
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What happened to them?
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Vet Used
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PLANS FOR YOUR NEW PET
Where will the cat live?
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Inside
Outside
Both
Are you committed to providing a lifelong home?
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Yes
No
Are you willing to bring the cat to a veterinarian regularly?
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Yes
No
Are you willing to allow an adjustment period?
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Yes
No
Are you able to afford all the necessary expenses for the cat?
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Yes
No
Where will the cat be when no one is home?
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PREFERENCES
Preferred Size
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Preferred Age
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Preferred Energy Level
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Preferred Breed Type
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Reason for adopting
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REFERENCES
Reference 1
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Ref. 1 Phone Number
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Ref 1 Relationship to You
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Reference 2
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Ref. 2Phone Number
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Ref. 2 Relationship to You
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Untitled
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Ref. 3 Phone Number
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Ref. 3 Relationship to You
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HOW DID YOU HEAR ABOUT US?
How did you learn about the current animal you are applying for?
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Saw picture on Facebook
Saw Picture on Webpage
Friend told me about it
Saw animal at shelter
Saw animal in newspaper
Friend tagged me on a Facebook post
Saw a photo on Instagram
Other
If Other please tell us.
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IMPORTANT NOTICE:
CHA reserves the right to refuse any adoption application.
Animals are not placed on a “first come first serve” basis, it based on the best fit for the animal.
The information contained within this application is accurate and not misleading in any way.
CHA reserves the right to contact any individual on this form including veterinarian & landlord.
CHA cannot guarantee the long-term health or temperament of any animal.
CHA will not consider any incomplete applications.
Please make sure all questions are answered and ask a staff member for clarification if necessary.
We also ask that you follow up with us regarding your application within five days of submitting it.
By checking the box below, you verify that you have read, understand and agree to the terms listed above.
*
I read, understand and agree to the terms listed above.
This is a required field if not checked the form will not submit.
Submit
Home
About Us
Adopt
Barn Buddy Program
WAYS TO GIVE
Events
Services & Resources
The Shelter Shop
Contact
Our Board
Employment
Barn Buddy Program
Newsletter