First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone

You must be 21 or over to submit an application*

Which cat are you interested in Adopting?*
Choose an animal: Baxter Buddha Buddy Callie Chester Chewie Cooper Dakota Dixon Duke Felix Flash Gracie Harley Juliana Leia Loki Luke Max Qi'ra Rey Rosalyn Selene Spicey Tommy Wheezy

List the names of any other cat you are interested in, or describe the type of cat you are interested in

Applicant Date of Birth*

Applicant Occupation (if retired, student or other please describe)*

Employer Name (retired, student, etc)*

Employer Phone Number (type N/A if retired, student or self-employed)*

PERSONAL REFERENCE #1: Name, Relationship to you, Address and Phone Number ***(Only one (1) can be a family member who DOES NOT live in the same household as you) LET THEM KNOW WE WILL BE CALLING*

PERSONAL REFERENCE #2: Name, Relationship to you, Address and Phone Number ***(Only one (1) can be a family member who DOES NOT live in the same household as you) LET THEM KNOW WE WILL BE CALLING*

Veterinarian's Name, Address and Phone Number (if more than one please list all), if None enter NONE.*

If you do not have a Veterinarian reference - we require a 3rd PERSONAL REFERENCE: Name, Relationship to you, Address and Phone Number *** (not a family member) LET THEM KNOW WE WILL BE CALLING

PET HISTORY: List all animals (current pets first followed by pets that have passed away) that have resided with you within the past 10 years. For each, include ALL of the following information: (1) Type of animal; (2) Breed; (3) Name; (4) How long they resided with you; (5) Were they up to date with inoculations; (6) Spayed/neutered? If not spayed/neutered or were not up-to-date with inoculations, please explain. (7) Is the pet alive or deceased?; If the pet is not deceased, but no longer living with you, please explain. If you have never owned a pet before, enter NONE * *

List ALL people living in the home (1) NAMES (2) RELATIONSHIP TO YOU (3) AGE - If you are the only household member Answer: NONE*

Who will be primarily responsible for caring for the cat?*

In what type of home do you live?*
Choose one: Single Family Condo Townhouse Apartment

Is the applicant listed the owner/renter of the home? (Yes/No) If no, list owner's name and phone # here, they must approve adopting a cat.*

Do you own or rent your home?*
Choose one: Own Rent

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent or have an HOA, provide 1. Landlord/Management Company Name 2. Phone Number

Are you prepared for the additional cost of food, cat litter and veterinary care?*
Choose one: Yes No

Cats will need an adjustment period after adoption. Are you dedicated to working with your cat until they fully adjust to your home environment?*
Choose one: Yes No

Some cats may need retraining to enforce appropriate litter box habits and scratching behavior. Are you willing and able to retrain the cat if needed?*

What arrangements will be made to care for your cat when you are away on vacation or an extended period of time? *

Will the cat be an indoor or outdoor cat?*
Choose one: Inside Only Outside Only Inside and Outside

If you own other cats, do they live indoor, outdoor or both?
Choose one: Inside Only Outside Only Inside and Outside

Would you consider declawing the cat (yes/no), if yes please describe why?*

If you own other cats, are they declawed?
Choose one: Yes No

If there is a new addition to your family (child, grandchild, etc), how will this impact the cat's life? *

Have you ever given up or re-homed an pet? If yes, explain in detail, why and where the pet is today - If you have NEVER given up a pet Answer: NA*

What circumstances would result in you returning your cat to NJSH Pet Rescue?*