A Few Steps From Home Dog Adoption Application

Name: Spouse Name:
E-Mail:
Date of Birth:
Address Line 1:
Address Line 2:
City:
State:
Country:
Phone number/cell:
Date of application submission:

May we contact you at work if needed? NoYes

Work Phone number:

Name of animal you are applying for. (if animal is not on web page, please be specific on breed, size, and age of the animal you are looking for) We will try to locate the right one for you!

do you currently have other pets in the home? NoYes

If you do have other pets, please list kind and age of them:

are you looking for an indoor cat? NoYes

How many children are living in your household currently?

please list childrens ages

how many adults are currently in your household?

Have the children in your home had any experience looking after, caring for and interacting with a cat or kitten? NoYes

Have your pets that have reached 6 months been spayed or neutered? NoYes

If not why?

Will you be willing to litter train if needed? NoYes

Who is your regular veterinarian? Address Line 1: Phone: City: State:

Please provide the names and phone numbers of three personal references. Please include one neighbor, if possible. Please do NOT include family members/relatives:

    Name: Phone:

    Name: Phone:

    Name: Phone:

    Are you ned to the experience of having a cat or kitten live with you?? NoYes

    If you are new to owning a cat/Kitten what made you decide to own a cat/kitten?

    Are you experienced living and dealing with cats? NoYes

    Please give a brief description of your experiences

    What would make you want to give up on your Cat? (example, clawing furniture, not using litter box, etc.)

    If your cat ran away what would you do?

    Have any of your pets ever ran away before? NoYes

    If so, How did it happen?

    Why are you looking for a pet? How long have you been searching?

    Will your cat(s) be alone during the day/ night?? NoYes

    How many hours will the cat(s) be alone during the day/night?

    where do you plan to keep the cat/kitten when it is alone? (i.e. a cage, outside, basement, etc.)

    If you move out of your current home, would you plan on taking the cat(s) with you? NoYes

    If you could not take your cat due to a move, relationship problems, children, or any other unexpected/expected situation what would you plan to do with your cat(s)?

    Who will care for your cat(s) when you go on vacations? where will they care for them at?

    Are you looking for a pet for yourself or someone else? If someone else, please explain who.

    Where did you hear about A Few Steps From Home?

    All of the information that I have provided in this application is true and accurate to the best of my knowledge.
    Applicant's Initials:

    Comments/Suggestions/Concerns

    No act of kindness, no matter how small, is ever wasted- Thank you for taking the time to fill out our application.

SPECIAL NOTE: Please Fill out entire application to the best of your ability. We MUST have a Veterinarian telephone number listed. Please understand we ask these questions because it is the only way we are able to tell if we are making the correct placement for not only the pet but for the family applying. If you object to filling out any information, we are sorry but you will NOT be eligible for one of our pets. Thank you for your time and understanding.

Copyright 2007 Created By Heather Smith - All Rights Reserved No part of this page shall be duplicated in any way under penalty of law.

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