Name: Pet Food Pantry Food Drive
Start: 2023-06-11T09:00:00-04:00
End: 2023-06-17T17:00:00-04:00
Location: SAFE Haven for Cats

Thank you so much for your willingness to open your home to a rescued cat or kitten from SAFE Haven for Cats!

After your Adoption Interest Survey is submitted, you may also get a call from one of our adoption counselors to discuss your thoughts about your new (cat) family member.

Note that fields marked with a * are required.

Your Information:

Your Name*

First Last

Are you 21 or older?*

Yes
No

Applicants must be 21 years old or older to adopt a cat from SAFE Haven. Please do not continue with the adoption form.

Cat Preferences and Expectations:

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 cat gender preference?*

Male
Female
No Preference

Will this be your first cat?*

Yes
No

How long do you expect it to take your new cat to adjust to its new home?*

1-2 days
About 1 week
2-3 weeks
A month or more

Current Pets:

Do you currently own pets?*

Yes
No

What type(s) of pets?*

Cat
Dog
Other

Tell us about your cat(s):

How many cats do you have?*

If over 6 cats, how many in total?*

Hidden

Cat #1:

Name

Age*

Is this cat sterilized?*

Yes
No

Is this cat declawed?*

Yes
No

Where does this cat stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Cat #2:

Name

Age*

Is this cat sterilized?*

Yes
No

Is this cat declawed?*

Yes
No

Where does this cat stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Cat #3:

Name

Age*

Is this cat sterilized?*

Yes
No

Is this cat declawed?*

Yes
No

Where does this cat stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Cat #4:

Name

Age*

Is this cat sterilized?*

Yes
No

Is this cat declawed?*

Yes
No

Where does this cat stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Cat #5:

Name

Age*

Is this cat sterilized?*

Yes
No

Is this cat declawed?*

Yes
No

Where does this cat stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Cat #6:

Name

Age*

Is this cat sterilized?*

Yes
No

Is this cat declawed?*

Yes
No

Where does this cat stay?*

Inside Only
Inside and Outside
Outside Only

Tell us about your dog(s):

How many dogs do you have?*

If over 5 dogs, how many in total?*

Hidden

Dog #1:

Name

Age*

Is this dog sterilized?*

Yes
No

Where does this dog stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Dog #2:

Name

Age*

Is this dog sterilized?*

Yes
No

Where does this dog stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Dog #3:

Name

Age*

Is this dog sterilized?*

Yes
No

Where does this dog stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Dog #4:

Name

Age*

Is this dog sterilized?*

Yes
No

Where does this dog stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Dog #5:

Name

Age*

Is this dog sterilized?*

Yes
No

Where does this dog stay?*

Inside Only
Inside or Outside
Outside Only

Tell us about your other pet(s):

How many other pets do you have?*

If over 2 other pets, how many in total?*

Hidden

Other Pet #1:

Type / Breed*

Age*

Is this pet sterilized?*

Yes
No

Where does this pet stay?*

Inside Only
Inside and Outside
Outside Only

Hidden

Other Pet #2:

Type / Breed*

Age*

Is this pet sterilized?*

Yes
No

Where does this pet stay?*

Inside Only
Inside and Outside
Outside Only

Past Pets:

Have you previously owned any pets in the last 5 years?*

Yes
No

Please list these pets and describe what happened to them.*

Household Information:

Household member(s):

How many household members including yourself?*

If over 4 household members, how many in total?*

Hidden

Yourself (Member #1):

Relationship*

Your Age*

Hidden

Household Member #2:

Name*

First Last

Relationship*

Age*

Hidden

Household Member #3:

Name*

First Last

Relationship*

Age*

Hidden

Household Member #4:

Name*

First Last

Relationship*

Age*

Are there any young children in your household?*

Yes
No

What steps would you take to protect both a young child and the pet?*

Please select your home type*

Single Family Home
Townhouse or Condo
Apartment
Mobile Home

Are you employed?*

Yes
No

Name of your employer*

Is your spouse or partner employed?*

Yes
No
Not Applicable

Name of your spouse or partner employer*

When home alone where will the cat stay?*

Other place(s) the cat will stay*

Do you have a pet door?*

Yes
No

When will the cat be allowed outside? 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

Discussion topics for your Adoption Counselor:

Please select the topics you would like to discuss in detail:*

List other discussion topics here

Do you plan to declaw your cat?*

Yes
No
Not sure, I need more information

Why do you plan to declaw your cat?*

How did you hear about SAFE Haven Cat for Cats? Select all that apply.*

Other ways you heard about SAFE Haven for Cats*

Any additional comments or questions?

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.

Your Full Name (Digital Signature)*

Address*

Street Address Address Line 2 City State ZIP Code

Home or Mobile Phone Number*

Work Phone Number

Email Address*

Email Confirm Email

Adopt a Cat

Adopt a Cat

Wayne Whiskers

Male - Mature Cat