Cocheco Valley Humane Society
Cat Adoption Information Request

Note: This Info will be forwarded by Email to the Cocheco Valley Humane Society

Which cat are you interested in adopting?:
Your Name:		Maiden Name:
Address:		Date of Birth:
City:		Spouse Name:
State:		Spouse DOB:
Zip Code:
Home Phone:		Work Phone:

Do you Please Select One Own Your Home? Rent A House? Rent An Apartment? Own A Mobile Home In A Mobile Home Park? Own A Mobile Home On Owned Land?
If you rent - Landlord's Name and phone:
How long at current address?:
If less than one year, please show previous address:

Are you: (Check all that apply)

Working Retired Attending School Homemaker Other

Other:

Your Employer:		Employer Phone:
Spouse/Partner's Employer:		Spouse/Partner's Employer's Phone:

E-mail Address:

Please be sure to include your entire e-mail address, including the "@" and ".com", ".net", etc.

Pets You've Owned in the Past Five Years
Name	Breed/Type	Age	Sex	Altered	Still Own	Kept Where	If no, what happened to this pet?




Who has been your veterinarian?

I like cats who are: (Check all that apply)

Short Hair Medium Hair Long Hair Declawed Any

I prefer a:

Please describe the temperament and activity level you are looking for in a cat. (Check all that apply):

Zippy, high-energy, kitten-like Mellow, easy-going A lap cat
Independent Very Affectionate Responsive Talkative Quiet

Someone in my home is nervous or unsure of cats: (Check all that apply)

Very Unsure Moderately Unsure Some (no experience with cats) N/A

I share my home with adults and children.

Ages of children:

I have children that visit or live next door.

Ages:

I have indoor cats(s), in/out cat(s), dog(s), and these other pets and livestock:

The noise/activity level in my home is usually:

Please Select One Low Medium High

When it comes to keeping a clean and tidy house, I am:

Please Select One Very Particular Particular Easygoing

I need a cat that will tolerate being alone hours a day.

Weekends For Frequent Short Trips

I'd enjoy brushing or grooming my cat:

Please Select One Rarely Occasionally Weekly Daily

Exercise
I prefer a cat whose energy level is:
Please Select One Low Medium High
I prefer a cat that:
	will enjoy living indoors.
	will enjoy being outside while I'm with him/her.
	will come and go independently.
	will enjoy living in our barn.

General
My ideal cat would:

Bad kitty habits that I just can't tolerate are:

It can take a new pet up to 2 months to adjust to a new home. Are you willing to devote this time?
Please tell us anything else you would like us to know about you or the cat you're looking for:

Please list two personal references:
Name:		Name:
Address:		Address:
Phone:		Phone:

Please check any areas you would like to discuss with an adoption counselor:
	What to feed your cat and how often
	Introducing your new cat to other pets
	Introducing your new cat to children and other family members
	Litterbox Training
	Housetraining
	Exercising
Other:

How will you handle the following?
Where will you keep your cat during the day, at night, or when you're not home?:

If you have to move?:

How will you care for your pet when you're on vacation or business trips?:

How will you handle bad habits such as marking, jumping on counters or furniture, nipping, scratching, scatching furniture, eating plants?:

Name:		Date:
Please only click once. By filling in your name and the date, and submitting below, you certify that: "The information I have given is true, and I authorize CVHS to contact veterinarians, landlords, and references to investigate all statements in the application, and to do follow-up property checks." After clicking "Send Info" you will need to click "OK" then "Send".