Are you 21 or older?*YesNoApplicants must be 21 years old or older to adopt a cat from SAFE Haven. Please do not continue with the adoption form.Date you want to adopt* Name* First Last What age cats are you interested in adopting? Check all you would consider. Adult Cat (1 year or older) Teenage Cat (6 months - 1 year) Kitten (3 months - 6 months) Mature Cat (5 years or older) Special Needs Cat What is your gender preference?MaleFemaleNo PreferenceWhat color would you prefer?What is your hair length preference? Check all you would consider. Short Medium Long No preference Why are you interested in adopting a cat or kitten? Check all that apply. Family Pet Child's Pet Companion for Yourself Mouser Gift Other (please specify) Other (please specify)Will this be your first cat?YesNoHow long do you expect it to take your new cat to adjust to its new home?1-2 daysAbout 1 week2-3 weeksA month or moreA cat can live 15-20 years and requires a major commitment of time, finances, and emotion. Do you feel you can make that kind of commitment at this time?*YesNoPet InformationDo you currently own pets*YesNoWhat type of Pet?* Dog Cat Other How many dogs do you have?How many cats do you have?How many other pets do you haveTell us about your cat(s) - click the + sign to add another row*AgeSterilized (yes/no)Does your cat stay indoors/outdoors/both?Declawed? (yes/no) Tell us about your dog(s) - click the + sign to add another row*AgeSterilized (yes/no)Does your dog stay indoors/outdoors/both? Tell us about your other pet(s) - click the + sign to add another row*Type/BreedAgeSterilized (yes/no)Does your pet stay indoors/outdoors/both? In addition to those listed above, what other pets have you had in the last 5 years?Please describe what happened to each of these pets.Do any of your current cats spend any time outdoors?YesNoPlease describe.Please list all household members including yourself.Household Member 1Name First Last RelationshipAgeAgree with new pet?YesNoHousehold Member 2Name First Last RelationshipAgeAgree with new pet?YesNoHousehold Member 3Name First Last RelationshipAgeAgree with new pet?YesNoHousehold Member 4Name First Last RelationshipAgeAgree with new pet?YesNoIf there are young children what steps would you take to protect both the child and the pet?Who would be responsible for the day-to-day care of the cat?Please check your home typeSingle Family HomeTownhouse or CondoApartmentMobile HomeIf you rent an apartment/home, what is the name of the community/complex?Owner/Management Company Phone NumberDo they allow pets?YesNoAre there any limits on the number of pets allowed?YesNoHave you paid the pet deposit?YesNoN/ADo you plan on moving in the next 12 months?YesNoHow long have you lived at your current address? (in years & months)If you move, will your pets go with you?YesNoIf no, please explainSuppose you move to an apartment or rental that does not allow pets, what would you do?Are you employed?YesNoWhere are you employed?Is your spouse or partner employed?YesNoN/AWhere is your spouse or partner employed?If you already have pets, please list your veterinarian's name.When will the cat be alone?When home alone where will the cat stay?GarageBasementOutdoorsOne roomWill have run of the houseWhere will the cat sleep at night?Do you have a pet door?YesNoWhen will the cat be allowed outside? Please check all that apply. When I am home On a leash only On a deck or patio Never In a fenced yard In a screened porch When the cat wants to be Out during the day only/in at night Please check off topics you would like your adoption counselor to discuss with you in detail: Litterboxes Feeding Grooming Nail trimming (demo provided) Biting Scratching (people) Scratching (furniture) Safe outdoor experiences Spraying Vaccinations Fleas/Worms Microchipping Introduction to resident cat Introduction to resident dog Adjustment to new home Kids & cats Allergies Kitten vs. Adult (better for my situation) Other If other, please specifyDo you plan to declaw your cat?*YesNoNot sure, need more informationWhy or why not?How did you hear about SAFE Haven Cat Shelter & Clinic* Veterinarian TV Radio Friend/Family SAFE Haven Event WRAL Pet of the Day (news at noon) News and Observer Google Search mync.com Facebook The Independent Petfinder.com Craig's List Twitter WRAL.com Classifieds LinkedIn Other If other, please specifyAny additional comments?Completion of this application means you are 21 years or older. These statements would become part of a written contract if you adopt from SAFE Haven.Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Work PhoneEmail* Enter Email Confirm Email Your Full Name (Digital Signature)*Because SAFE haven is trying to find the best match for our animals, we reserve the right to turn down any potential adopter based on this application.