This electronic application will be forwarded by e-mail to SAFE Haven For Cats for review. We will get back to you as quickly as possible. Please complete all questions. Completion of this application means you are 21 years of age or older. This application will become part of a written contract if you adopt from SAFE Haven For Cats. Because SAFE Haven For Cats is trying to find the best match for our animals, we reserve the right to turn down any potential adopter based on this application.

 

Adoption Preferences
What age cat are you interested in adopting? Please check all that you would consider
Adult Cat 1 Yr + Special Needs Cat		Kitten (6 Mos - 1 Yr) Kitten (3 Mos - 6 Mos)
What characteristics are you interested in for your new cat?
Sex      Male     Female
Color
Hair     Short     Medium      Long
Why do you want to adopt a cat or kitten?
Family Pet		Companion for Self
Child's Pet		Companion for Pet
Gift
Other (explain below)

Pet Information
What pets do you currently have?
Pet Type		Sterilized		Housing		Age
Cat Dog Other		Yes No		Indoor Only Outdoor Only Indoor/Outdoor
Cat Dog Other		Yes No		Indoor Only Outdoor Only Indoor/Outdoor
Cat Dog Other		Yes No		Indoor Only Outdoor Only Indoor/Outdoor
Please describe other pet types if selected above or tell us about additional pets you may have:
In addition to those listed above, what other pets have you had in the last five years?
Please described what happened to each of these pets:
Do any of your current cats spend any time outdoors? Yes (explain below)    No     N/A

Your Household
List Members of your Household (begin with yourself)
Name		Relationship		Age		Agrees w/ Getting Pet
		Self		-2 Yrs 2-5 Yrs 6-11 Yrs 12-15 Yrs 16-20 Yrs 21-35 Yrs 36-50 Yrs 50+ Yrs		Yes No
		Spouse Parent Child Adult		-2 Yrs 2-5 Yrs 6-11 Yrs 12-15 Yrs 16-20 Yrs 21-35 Yrs 36-50 Yrs 50+ Yrs		Yes No
		Spouse Parent Child Adult		-2 Yrs 2-5 Yrs 6-11 Yrs 12-15 Yrs 16-20 Yrs 21-35 Yrs 36-50 Yrs 50+ Yrs		Yes No
		Spouse Parent Child Adult		-2 Yrs 2-5 Yrs 6-11 Yrs 12-15 Yrs 16-20 Yrs 21-35 Yrs 36-50 Yrs 50+ Yrs		Yes No
		Spouse Parent Child Adult		-2 Yrs 2-5 Yrs 6-11 Yrs 12-15 Yrs 16-20 Yrs 21-35 Yrs 36-50 Yrs 50+ Yrs		Yes No
		Spouse Parent Child Adult		-2 Yrs 2-5 Yrs 6-11 Yrs 12-15 Yrs 16-20 Yrs 21-35 Yrs 36-50 Yrs 50+ Yrs		Yes No
If there are any young children in your household, what steps would you take to protect both the child and the pet?
Who will be responsible for the day-to-day care of the cat?
Do you live in:
Single Family Home Townhome Condominium Mobile Home

If You Rent an Apartment or Home
Name of Community
Owner or Mgmt Company		Phone
Do they allow pets?		Is there a limit on the number of Pets?
Yes No Don't Know		Yes No Don't Know
Pet Deposit Required?		Have you paid the Pet Deposit?
Yes No Don't Know		Yes No N/A Don't Know

Future Home Plans

Do you plan to move in the next 12 months?

Yes No Don't Know

How long have you lived at your current address?

Years    Months

If you move, will your pets go with you?

Yes     No (please explain below)

Suppose you move to an apartment or rental that does not allow pets. What would you do?

Employment Information
Please enter your (and/or Spouse's) Employment Information
Name		Where Employed		How Long

Pet Care and Home Environment
If you already have pets, who is your veterinarian?
When will the cat be alone?
When home alone, where will the cat stay?
Garage Basement Other (please explain)		Outdoors One Room in House Run of the House
Where will the cat sleep at night?
Do you have a pet door?
Yes     No
When will the cat be allowed outside?
When I am Home On a Leash Out during day; In at night Other (please explain)		When the Cat wants On Screened Patio On Deck or Patio Never
Under what circumstances might you consider giving up your cat?
Moving Baby Separation/Divorce Allergies Medical Problems Other (please explain)		Children Lost Interest Too Time Consuming Biting Scratching Spraying Behaviorial Problems
Do you plan to declaw your cat?
Yes     No     Not sure - need more information
Why or why not?

Administrative and Contact Info
How did you hear about SAFE Haven For Cats? Check as many as apply:
Veterinarian Newspaper Store Flyer		Friend or Relative Radio or TV Internet Search PetFinder.com
Do you have any additional comments?
Acknowlegement Completion of this application means that you are 21 years or older. These statements would become part of a written contract if you adopt from SAFE haven For Cats.
First Name		Last Name
Address 1		Address 2
City		State	Zip
Day Phone		Evening Phone
Select Type... Home Office Wireless		Select Type... Home Office Wireless
E-Mail		Best Time to Contact You
Thank you for completing the application form.