Adopt a Cat Adoption Interest Survey Adopt a Cat Adoption Interest Survey Complete this Interest Survey if you would like to adopt a cat. 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?*Select1 cat2 cats3 cats4 cats5 cats6 catsMore than 6 catsIf over 6 cats, how many in total?*HiddenCat #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 HiddenCat #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 HiddenCat #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 HiddenCat #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 HiddenCat #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 HiddenCat #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?*Select1 dog2 dogs3 dogs4 dogs5 dogsMore than 5 dogsIf over 5 dogs, how many in total?*HiddenDog #1:Name Age*Is this dog sterilized?* Yes No Where does this dog stay?* Inside Only Inside and Outside Outside Only HiddenDog #2:Name Age*Is this dog sterilized?* Yes No Where does this dog stay?* Inside Only Inside and Outside Outside Only HiddenDog #3:Name Age*Is this dog sterilized?* Yes No Where does this dog stay?* Inside Only Inside and Outside Outside Only HiddenDog #4:Name Age*Is this dog sterilized?* Yes No Where does this dog stay?* Inside Only Inside and Outside Outside Only HiddenDog #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?*Select1 other pet2 other petsMore than 2 other petsIf over 2 other pets, how many in total?*HiddenOther Pet #1:Type / Breed* Age*Is this pet sterilized?* Yes No Where does this pet stay?* Inside Only Inside and Outside Outside Only HiddenOther 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?*SelectOne (just myself)Two membersThree membersFour membersMore than four membersIf over 4 household members, how many in total?*HiddenYourself (Member #1):Relationship* Your Age*HiddenHousehold Member #2:Name* First Last Relationship* Age*HiddenHousehold Member #3:Name* First Last Relationship* Age*HiddenHousehold 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?* Garage Basement Outdoors One room Will have run of the house Other 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:* 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 topics List other discussion topics hereDo 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.* Google Search Friend/Family WRAL Pet of the Day Previous Adopter Facebook Instagram SAFE Haven Event Volunteer Petfinder.com TV/Radio Veterinarian Prefer not to say Other Ways 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home or Mobile Phone Number*Work Phone NumberEmail Address* Email Confirm Email Featured Cat JulienMale - Adult Upcoming Events Sep26Volunteer Open HouseSAFE Haven for Cats
