Adoption Application
Instructions:
1) Please print neatly and clearly and circle answers
2) Provide required information, missing information will delay your application.
3) All references must be contacted before you can adopt.
PLEASE NOTE:
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We do not run adoptions on a “first come, first served” basis, we try to find the best home for each cat.
Chance At Life Cat Rescue is an all-volunteer, non-profit organization. The adoption fee covers our
veterinarian bills and care for the rescued cats. The fee is NON-REFUNDABLE, and to be paid at the time
of adoption, no exceptions. We reserve the right to refuse any adoption that we feel is not in the best
interest of the cat, or the adopter.
Section 1 – Personal Information
Date: ________________________
Volunteer Assisting: __________________________________________
What type of cat are you seeking to adopt?
___ Cat
___ Kitten
First Name
Middle Name
Street Name & Number
___ Male
___ Female
Last Name
City
Daytime Phone #
State/Zip
Cell Phone #
Evening Phone #
E-mail Address
Section 2 – Tell Us About You!
1. How did you hear about Chance At Life Cat Rescue?
2. What type of house do you live in? __Single family
3. Do you:
Own
Web
TV
Paper
Friend/Relative
__ Multi-family __Condo/Townhouse
Walk-in
__Apartment
Rent If renting, Landlord’s name & phone # ___________________________________
4. Make up of household (# of people) _____ Adults _____ Children Ages of Children: ___________________
5. Do any of the persons listed above have allergies?
___ Yes
___ No
6. What is your reason for wanting a cat? __ House pet/Companion __Gift Other/Explain: ________________
7. Will this be your first cat? ___ Yes ___ No
8. How much are you prepared to spend for routine/emergency medical care, licensing, etc.?
9. Which family member will have the major pet care responsibility?
____ Children ____ Family
____ Other Relative
10. Do you currently have any other pets?
Type (Cat, dog, Other)
Age
___ Yes
____ Applicant ____ Mom/Dad
____ Neighbor
___ No
Spayed or Neutered
How long have you had them?
11. Is a change in residence possible within the next few years?
___ Yes
___ No
12. If you were moving to a residence that did not allow cats, to whom would you give the cat?
13. Who is your current or previous veterinarian?
Name & phone # (include name of pet and last name records are under
14. If adopting a kitten, where will the kitten be kept when alone? _______________________________________
15. Where will the cat sleep at night?
____ Indoors
16. How many hours a day will the cat spend:
____ Outdoors
Indoors ____ # of hours
Outdoors _____# of hours
17. Where do you primarily plan to keep the cat? __ Indoors __ Basement _ Outdoors __ Garage __ Confined
18. Do you plan on declawing the cat?
___ Yes
___ No
___ Maybe
19. If your cat displays behavioral problems (such as poor litter box habits, inappropriate scratching, etc.) how
would you go about correcting the behavior?
___ Contact a professional
___ Use a book
____ Personal knowledge
____ Other
19a. What type of solution would you be willing to try if litter box accidents continue after the first week?
(Circle all that apply)
Move box to a new location
Try different litter
Clean box more often
20. Some pets may take 30 days or more to adjust. Are you willing to give this pet time to adapt to its new
environment and family members?
___ Yes
___ No
21. Have you ever lost or given away a pet?
___ Yes
___ No
If Yes, please explain: _____________________________________________________________________
22. Have you ever had a pet killed by a vehicle?
___ Yes
___ No
23. Please describe the typical work schedule of the person taking care of the cat:
(i.e., work from home, work M-F, 9-5) _________________________________________________________
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Section 3 – Our Information
24. Do you understand that there is a non-refundable adoption fee to help cover the expenses of spay/neuter
surgery, inoculations and general care for the cats?
___ Yes
___ No
25. If requested, are you willing to provide written proof that your current pet is spayed/neutered? __ Yes __ No
If no, please explain: _____________________________________________________________________
26. Do you fully understand and agree, under Chance At Life Cat Rescue contract rules; the cat you are seeking to
adopt will be spayed/neutered?
___ Yes
___ No
27. If you are adopting a cat/kitten that has not been altered, are you willing to send a copy of the spay/neuter
certificate to Chance At Life Cat Rescue once the procedure is completed? ___ Yes
___ No
28. Do you fully understand that if you qualify and adopt a pet from Chance At Life Cat Rescue, you WILL be
contacted for further verification of the cat’s welfare and will cooperate by providing requested information
which MAY include a visit to your home by Chance At Life Cat Rescue?
___ Yes
___ No
29. Do you fully understand and agree that if your adopted cat should not work out in your home, that under
Chance At Life Cat Rescue contract rules, the cat must be returned to Chance At Life Cat Rescue?
___ Yes
___ No
30. In the event that you qualify and adopt a cat from Chance At Life Cat Rescue, are you willing to provide us with
written follow-up reports, if requested?
___ Yes
___ No
31. Do you fully understand that Chance At Life Cat Rescue reserves the right to refuse any adoption that we feel
is not in the best interests of the cat or the adopter?
___ Yes
___ No
Section 4 – References
Please provide three (3) references. These references MUST NOT be related to you, NOR SHOULD THEY
RESIDE WITH YOU. All references MUST be contacted BEFORE you can qualify for adoption.
Full Name
Full Address
Home/work/cell
phone #’s
How long
acquainted?
Section 5 – Signatures
Print Name (person who filled out form) _________________________________________________
Date __________________ Signature ___________________________________________________
Chance At Life Cat Rescue Volunteer Initials: __________
Chance at Life Cat Rescue
P.O. Box 4093
River Edge, NJ 07661-4093
Date: _________________________
Vanessa Staiger, President:
Website: www.chanceatlifecatrescue.com
Email: [email protected]
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(201) 982-2219