Cat Application

Thank you for your interest in adopting a pet from the Montgomery County SPCA!   Please complete all sections of this application.

 PLEASE PRINT – Incomplete or illegible applications cannot not be processed.

 

DATE ______________________________      Name of cat(s) you are interested in ____________________________________________________________________ 

APPLICANT _____________________________________________________________________________________________________________________________

CO-APPLICANT  (relationship)________________________________________________________________________________________________________________

ADDRESS ______________________________________________________________________________________________________________________________

CITY____________________________________________________   STATE ____________   ZIP _______________    HOW LONG AT ADDRESS? __________________

PHONE:  Home _____________________________  Work ____________________________________ Cell_________________________________________

E-MAIL ADDRESS ____________________________________________________________________________

EMERGENCY CONTACT NAME (not in the same household):  ______________________________________________ EMERGENCY PHONE   _______________________________

Do you rent?   □ NO  YES                If YES, please provide the following:  (REQUIRED FOR ADOPTION CONSIDERATION)

LANDLORD’S FULL NAME ____________________________________________________________________________________________________________

ADDRESS ________________________________________________________________________________________________________________________

CITY________________________________________________________________    STATE ____________________________      ZIP ____________________

PHONE:  Home _____________________________ Work ________________________________________ Cell _______________________________________

Does your landlord allow cats?   □ NO   YES

Applicant’s  Employer ______________________________________________________________________________________________________________

Supervisor’s name_________________________________________________________________________________________________________________

Address  ________________________________________________________________________________________________________________________

City _______________________________________________________ State ______________ Zip ______________  Phone __________________________

Co – Applicant Employer ____________________________________________________________________________________________________________

Supervisor’s name ________________________________________________________________________________________________________________

Address  ________________________________________________________________________________________________________________________

City _______________________________________________________________________State ______________ Zip ________ Phone ___________________

If you are not employed, who will be financially responsible for the cat?  __________________________

Name(s) of adults in home who will be responsible for the care of cat: ______________________________

Number of adults in home: __________   Number of children in home _________  Ages: _____________

Other pets in your home:

1.  Name: _______________________________________________   Age: _____________   Temperament: ________________________________________________

Dog   □Cat  Other___________                          Male  Female                                 Altered: NO  YES                                Rabies current? NO  YES

2.  Name: _______________________________________________   Age: _____________   Temperament: ________________________________________________

Dog   □Cat  Other___________                          Male  Female                                 Altered: NO  YES                                Rabies current? NO  YES

3.  Name: _______________________________________________   Age: _____________   Temperament: ________________________________________________

Dog   □Cat  Other___________                          Male  Female                                 Altered: NO  YES                                Rabies current? NO  YES

4.  Name: _______________________________________________   Age: _____________   Temperament: ________________________________________________

Dog   □Cat  Other___________                          Male  Female                                 Altered: NO  YES                                Rabies current? NO  YES

Are you seeking a barn cat?       □ NO   YES              Is the cat a gift for someone?    □ NO  YES 

Are you seeking a mouser?        NO    YES             Where will the cat be housed?    □ INSIDE  OUTSIDE 

Why do you want to adopt this cat? ___________________________________________________________________________________________________

Are you committed to caring for this cat for a lifetime?   NO    YES  

Are ALL members of household in full agreement to adopt and take responsibility for the cat?   □ NO    YES

How long will this cat be left alone at any given time? ______________________________________

Does any member of your household have animal-related allergies or asthma?   □ NO    YES

Have you previously owned a pet that is no longer in your household?   NO  YES

If yes, why is the pet no longer in your home?____________________________________________________________________________________________________

Are you willing and financially able to provide all future veterinary care for this cat, including periodic exams, all inoculations and any emergency treatment required?   □ NO    YES

Veterinarian Name _______________________________________________________________________________   Phone _________________________________

Please provide two character references (non-family):

1.  Name ______________________________________________ Relationship ___________________________   Phone _________________________________

2.  Name ______________________________________________ Relationship ___________________________   Phone _________________________________

 

By signing:

 *  I/We affirm that the information provided by me/us in this application is true to the best of my/our knowledge.  I/We understand that any misrepresentations of fact may result in the removal of an adopted pet from my/our home by the MCSPCA. 

*  I/We understand that if I/we are approved for adoption, I/we will be required to make a substantial commitment of time and money for up to 20 years for the adopted cat.

*  I/We authorize release of information to the Montgomery County SPCA of any police and veterinarian records.

 

APPLICANT SIGNATURE _________________________________________________________________________________________________________________

CO-APPLICANT SIGNATURE _______________________________________________________________________  DATE _________________________________

 

 FOR STAFF USE ONLY   

 

Name of staff/volunteer who assisted adopter______________________________________________________________  Date_____________________________

Preferred date/time for Home Visit __________________________________________________Date/time HV____________________________  □  Shelter         PetSmart

 

Revised 2.2012