Date Cat(s) you are interested in adopting Title DR MISS MR MRS MS First Name * Last Name * Cell Phone Number Home Phone Number Home Address * City * State * Zipcode/Postcode * Country * -- Select Country -- AFGHANISTAN ALAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CÔTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT BARTHÉLEMY SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA VIETNAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE Email Address * Age * Occupation * Spouse/Significant Other Name Spouse/Significant Other Occupation Do you have any children? * Yes NoIf yes, please list their ages Have they been around cats before? Yes NoIf yes, when and where? Do you live in a * House Apartment Condo Townhouse OtherIf other, please specify How long have you lived at your current address? * Do you currently * Own your home? Live with parents/family? Rent your home?If you rent or live in a condo/townhouse, does your landlord or HOA allow pets? Yes NoLandlord's name and phone number Do you have a dog or cat door? * Yes NoWill the cat(s) or kittens have access to (check all that apply) * Balcony Patio Yard None of the aboveHow many hours a day will your foster cat(s) and/or kittens be left unattended? * 24 hrs 18-24 hrs 12-18 hrs 8-12 hrs 4-8 hrs 1-4 hrs NeverIs anyone in your household allergic to cats? * Yes No Don't knowHave you ever owned cats before? * Yes NoIf yes, when? What happened to them? Do you expect to move in the next few months? * Yes No Don't knowWhat would happen with the cat if your relationship changed? * What would happen if you became unable to care for the cat? * What would happen if the cat's personality became unsuitable for you? * What would happen if someone in your household suddenly became allergic to the cat? * Have you ever declawed a cat? * Yes NoWhat other types of animals do you currently have? (Check all that apply) * Cat(s) Dog(s) Other NoneHow many and what breed(s)? Are all of your animals spayed/neutered? Yes NoAre their vaccinations current? Yes No Don't knowAre your cats tested for feline leukemia and feline aids? Yes No Don't knowWhen and where were your cat(s) tested? * If you have dog(s), have they been around cats before? Yes No Don't knowIf so, when and where? What type of food will you feed this cat? * Dry CannedPlease list brand * Can you afford regular veterinary costs for serious injury or illness for this cat that can run $1,000 or more? * Yes NoHave you ever had pet insurance? * Yes NoWould you consider pet insurance for your new pet? * Yes NoDo you or anyone in your household smoke? * Yes NoIf yes, who? What would you do if your cat suddenly stopped using the litter box? * What would you do if your cat clawed and destroyed your good furniture? * What would you do if the cat kept trying to get outside? * Which of the following reasons would cause you to give up this cat? (Check all that apply) * New baby Moving Illness (your own or family member) Divorce/separation Unemployment Not getting along with other pets Scratching furniture Peeing on furniture OtherIf other, please explain What breed/color/personality of cat would you like for your family? * Why are you adopting a cat? (Check all that apply) * Companion for me Companion for another pet My child wants a cat Mouser Gift for another person OtherIf other, please explain If you had a previous pet put to sleep, what source did you use? * Vet Animal shelterWho will be responsible for the daily care and maintenance of this cat? * Have you ever bred a pet? * Yes NoIf so, what type of pet was it? Did you breed for (check all that apply) Show Fun Profit Accident Miracle of birthYou may have to adjust your lifestyle to accommodate your new pet(s). If you are ready to make this commitment, initial here By signing my name below, I agree that I will not hold Furever Purr Rescue responsible for any damage or injury that may occur as a result of handing the cat(s). I further agree that all information provided is true and correct. *