Applicant’s Name       

Applicant’s address   

Is this a:                       House    Apartment     Duplex     Trailer/Mobile Home     Farm      Other (Please Explain)

Do you:                       Own     Rent    Lease                                               

Home Phone                    E-Mail Address   

Cell Phone                        Work Phone     

If you do not own, please provide name and phone number of landlord:

Landlord Name:                  Phone:   

When does your lease expire?   

How long at this address?   

Number of adults at this address         Number of children at this address:       

Ages of children at this address:   

Does anyone in the family have any known allergies to animals?     Yes     No   

Name of Employer:     

               Address:        

                City:                    State:        Zip Code:   

                Phone:          

                How long have you been employed here?   

Are you a student?      Yes   No

Are you adopting for yourself or for someone else?        Self    Someone Else

Will the cat or kitten  live at the address above?      Yes      No

        If no, at what address will kitten will be living   

Do you plan on declawing this cat or kitten?    Yes   No?

Do you know about the safe alternatives to declawing?     Yes   No

How many dogs do you own?            What are their breeds and ages?

            Breed:            Age:   

             Breed:            Age:   

             Breed:            Age:   

             Breed:            Age:   

             Breed:            Age:   

Are your dogs kept:    Inside   Outside    Inside and Outside?     Are they spayed or neutered?  Yes  No

How many cats do you own?              What are their breeds and ages?

             Breed:            Age:   

             Breed:            Age:   

             Breed:            Age:   

             Breed:            Age:   

             Breed:            Age:   

Are your cats     Inside   Outside    Inside and Outside?     Are they spayed or neutered?  Yes  No

What is the name of the vet clinic that you use? 

What is the name of your vet?        Phone:   

Are all of your animals current on all of their vaccinations?  Yes  No

If you have had pets in the past but no longer have them, please tell us a little bit about how long you had them and what happened to them:

Where will this cat or kitten spend most of its time?  Inside    Outside    Garage    Inside/Outside Equally

Would you object to a home visit prior to adoption completion?      Yes  No

Would you object to a follow-up home visit after adopting?      Yes  No

While it is the intent of Caring Hearts to find permanent, loving, stable, and responsible homes for all of its cats and kittens, we do reserve the right to refuse adoption.

***Anyone who misleads or fails to provide accurate information on this application will be denied all adoption rights. ***

All of the cats and kittens available for adoption from Caring Hearts have been cared for in foster homes by dedicated volunteers who have a vested interest in finding their charges PERMANENT and LOVING homes.  When you adopt a kitty from Caring Hearts, we expect you to make a lifetime commitment to the care of this feline.  If, however, you ever find yourself unable to properly care for this cat, will you make every effort possible to return the cat to Caring Hearts?

  Yes  No