Document Sample
					Adoption Application
Volunteer: _____________________Adoption Date: ______________ Location: ___________________
In order to be considered for an adoption you must: 1) be 21 years of age; 2) have the knowledge and consent of all adults living in your household;, 3) have a valid ID with current address; 4) understand that completing this application does not guarantee adoption and that the West End Cat Rescue must approve your application.

About You (After typing an answer, hit the Tab button to move to next field.) Name Spouse/Roommate Address City How long at current address? Home phone Work phone Driver’s Lic. # # Adults in home Current employer Spouse employer Cell E-mail address State # Children Current occupation Spouse occupation No No No State Zip Age Age

If you rent, do you have permission from your landlord to get a cat? Yes Are you fully aware of the pet deposit and monthly fees, if any, you Yes must pay to have a cat on the rental property? May we have your permission to contact your landlord? Yes If so, what is your landlord's name? What is your landlord's phone number?

Adoption Request Which of our adoptable pets are you interested in? (If not sure, skip to next question.) What type of cat are you looking for? Pet History Will this be your first pet? Yes Is your current cat declawed? Yes Have you ever had a was hit by pet that a car? Has your cat(s) been tested for Feline AIDS or Feline Leukemia?

No NA ran away? Yes No was stolen? died in your care? NA

Form last revised 2/29/08

Your Veterinarian/Medical Considerations Who is your veterinarian? Vet phone number: Would you like us to provide vet recommendations? If you are adopting a kitten that is not neutered / spayed are you willing to alter your pet when it is old enough? Pet Environment Is this pet for you or another family member? If for another family member, who? Address where pet will live if different from above What pets do you currently have in your household? Type Spayed/Neutered? Name/Breed Cat Cat Cat Cat Cat Cat Cat Dog Dog Dog Dog Dog Dog Dog Yes Yes Yes Yes Yes Yes Yes No No No No No No No Kept where? In In In In In In In Out Out Out Out Out Out Out Age Yes No

Have you prepared a place for your new pet to sleep, play, and eat? Are you willing to modify your home to accommodate a new cat or kitten? When on vacation or away from home, who will take care of your pet(s)? Are you or a member of your immediate family serving in the military or plan to serve? If Yes, who will care for your pet if deployed? Are you willing to have a WECR volunteer visit your home? If no, please explain:

References Please list 3 references (only one family member, please). Name Relationship

Phone Number

Form last revised 2/29/08

please initial each statement in the box provided
In signing this agreement, I become the legal owner of the described pet. I / We will keep the animals and children supervised at all times. I / We will teach our children to be respectful of their new pet....hitting, teasing, pulling ears or tails may result in the cat biting or clawing them. Having a pet is a wonderful opportunity to teach your children about unconditional love and respect for all living creatures. I/ We will provide our new pet with food, water, indoor housing, and all of the love and comfort that they deserve. I / We will keep all animals current with their vaccinations and checkups.. For unneutered/unspayed animals, I am obligated to spay/ neuter this animal with in 30 days of this date of adoption or within 30 days of this animal reaching sexual maturity, whichever comes first. I /We will keep our cats indoors for safety reasons, and we will not have them declawed. If, for any reason, I / We find we are unable to keep and maintain the animal, I / We agree to contact West End Cat Rescue BEFORE any action is taken to give away or sell to another individual, surrender to any shelter, pound or animal welfare organization other than West End Cat Rescue or to euthanize the animal for other than verifiable heath reasons. Further, I / We understand that failure to contact West End Cat Rescue in such a situation is a breach of this binding contract and is actionable under the laws of the State of Virginia West End Cat Rescue makes no claims or representations regarding the behavior, health or temperament of animals offered for adoption. We make every reasonable and customary effort to ensure the health of the animals; however there are no guarantees. I /We have read, understood and agree to all of the terms in this contract. I / We hereby release West End Cat Rescue, all volunteers, and its Board of Directors and trustees from any and all liability for injuries or damages to person or property caused by the adopted or fostered animal.

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Form last revised 2/29/08

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