Name:
Address:
City:
State:
Zip Code:
Email Address:
Home Phone:
Cell Phone:
Occupation:
Age:
Name of Animal you are interested in:
Please Indicate why you are interested in adopting this pet(s) (check all that apply)
How many adults live in your household?
Do any children live in your household?
--Select One-- Yes No
If you have children, what are their ages?
What pets do you currently have?
In addition to those listed above, what other pets have you had in the last five years?
Please describe what happened to each of those pets (put to sleep, run over, died of old age, given away, killed, etc. please be specific
Do any of your current pets spend any time outdoors?
--Select One-- Yes No NA
If yes, please describe.
Does your pet(s) have front claws?
--Select One-- Yes No NA
Please list your current Veterinarian's name:
Please list your current Veterinarian's phone number
How much to you expect to pay annually for pet care (Vet care, food, toys, vaccines, etc.)
$
What percentage of time will the cat live indoors?
Pets can live for 10, 15 and even up to 20 years. Can you provide a permanent home for that length of time?
--Select One-- Yes No
How many hours per day will your pet spend alone?
When home alone, where will this pet stay?
How will you handle scratching and/or desctruction?
Will you declaw this pet?
--Select One-- Yes No NA
Under what circumstances might you consider giving up your pet?
Have you ever given up a pet in the past?
--Select One-- Yes No
If Yes, Why?
Please Indicate where you live.
--Select One-- Own Rent NA
Are pets allowed?
--Select One-- Yes No
What type of residence?
Please List the Name and Number of your landlord
How long have you lived at your current address?
How many times have you moved in the past 5 years?
If you move will your pets go with you?
--Select One-- Yes No
Suppose you move to an apartment or rental that does not allow pets, what would you do?
When traveling, who will take care of your pet?
Are you willing to allow a representative from NMHPKC to visit your home by appointment?
--Select One-- Yes No
