Name:		Home Phone:
Address:		Work Phone:
City:	State:	Zip:
Email address:

Cat you are applying for: 1. What type of cat are you interested in? Sex:   [_] M   [_] F    Age:            Color:            Hair length:            Declawed? 2. Please indicate why you are interested in adopting a cat (check all that apply): [_] Family Pet     [_] Child's Pet     [_] Companion for Self     [_] Mouser     [_] Gift     [_] Companion for other Pet     [_] Other 3. Is there anyone in your household that does not know about the adoption of this cat?    [_] Yes    [_] No     If yes, who will it be and why? 4. Is anyone in your house allergic to cats?   [_] Yes    [_] No If yes, what steps will you take to accommodate the cat and the household member? 5. How many adults live in the household? 6. Do any children live in your household?   [_] Yes    [_] No If yes, please list the number of children in the home and the age of each child. 7. Who will be primarily responsible for the daily care of this cat? 8. How will your children play with or handle your cat? 9. How much interaction will members of your household have with the cat? 10. How many hours a day will the cat be alone? 11. When home alone, where will the cat stay? (Check all that apply) [_] Garage     [_] Basement     [_] Run of the house     [_] Outdoors     [_] One room of the house     [_] Other 12. Where will the cat sleep at night? (Check all that apply) [_] Garage     [_] Basement     [_] Run of the house     [_] Outdoors     [_] One room of the house     [_] Other 13. How will you handle litter box training/problems if they occur? 14. How will you handle scratching and/or destruction if they occur? 15. Will you declaw this cat?    [_] Yes    [_] No    [_] Not sure 16. Have you ever had behavioral problems with a pet?   [_] Yes    [_] No If yes, please describe the problem and how you handled it. 17. What pets do you currently have?

Name	Type (dog, cat)	Age	Spayed/ Neutered?	Vet they see & phone number	Current on vaccinations?

18. What other pets have you had in the last 5 years?

Name	Type (dog, cat)	Vet they saw	Phone number	What happened to the pet?

19. Do you plan on using a different vet for this new cat?   [_] Yes    [_] No If yes, why? 20. How much do you expect to pay annually for pet care (vet, medicine, food, toys, etc)? 21. What percentage of the time will the cat live indoors? _________ % 22. Do you have a pet door?    [_] Yes     [_] No 23. Under what circumstances might you consider giving up your cat? [_] Moving     [_] Baby     [_] Separation/Divorce     [_] Behavior problems     [_] Medical problems     [_] Children lost interest     [_] Time consuming     [_] Allergies     [_] Biting     [_] Scratching     [_] Spraying     [_] Not getting along with other pets     [_] Other 24. Have you ever given up a pet in the past?   [_] Yes     [_] No If yes, please describe what happened 25. What will happen to the cat if you move? 26. Please check where you live: [_] Apartment     [_] Condo     [_] Townhouse     [_] Mobile home     [_] Single family home Do you rent?   [_] Yes     [_] No If yes, does your landlord allow pets?     [_] Yes     [_] No If yes, what type of pets do they allow? Is there a size restriction?     [_] Yes     [_] No     [_] NA Is there a number limit?     [_] Yes     [_] No     [_] NA Please list the name and phone number of the landlord: 27. How long have you lived in your current residence? 28. How often have you moved in the last five years? 29. Do the primary caregivers of the animal travel often?    [_] Yes     [_] No 30. When traveling, who will take care of the pet? 31. Are you willing to allow a CARA representative visit your home by appointment?    [_] Yes    [_] No 32. Please list references that are familiar with your life style (one that is a relative, two that are not related).

Name	Address	Telephone Number

33. Are you aware that there is an adoption fee involved?    [_] Yes     [_] No By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for rejection of this application and possible removal of adopted cat from my home. I consent to CARA representatives discussing information on this application with any persons named on this application. Applicant must be 18 years or older. CARA reserves the right to refuse any applicant for any reason. All completed applications become property of CARA. Signed: ________________________________________________ Date: _____________________

FOR OFFICIAL USE ONLY Interviewed by: Date: Comments: Application:     [_] Approved     [_] Declined Foster Signature: Date: Reason for decline: Required for all applications Cat Coordinator Signature: Date:

Form version 4/2003