CAT ADOPTION APPLICATION/QUESTIONNAIRE VERMILION COUNTY ANIMAL SHELTER CATLIN TILTON RD. DANVILLE, IL

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1 CAT ADOPTION APPLICATION/QUESTIONNAIRE VERMILION COUNTY ANIMAL SHELTER CATLIN TILTON RD. DANVILLE, IL Note: We reserve the right to refuse any adoption we consider unsatisfactory. Date: Date of Birth: Name Address City/State Zip County Primary Phone Alternate Phone Driver License Name of cat you are interested in Your reason for choosing this cat Thank you for considering the adoption of a shelter animal! Before you decide to adopt a pet, please consider the time, effort and funds for food, supplies, vaccinations and veterinary care necessary to properly maintain an animal. The decision to adopt a pet is an important one. In order to insure that you and your pet will be happy for years to come, we need you to take time to discuss your and the animal s individual needs and personality traits. Please take a few minutes to read and complete this application. If there is more than one application submitted, the adopter that best meets the needs of the cat/kitten will be approved. THE FOLLOWING CONDITIONS MUST BE MET IN ORDER TO APPLY: APPLICANTS MUST BE 18 YEARS OF AGE, ALL RESIDENTS OF HOUSEHOLD MUST AGREE TO ADOPTION. CHILDREN AND ALL RESIDENTS OF THE HOUSEHOLD MUST MEET WITH THE CAT PRIOR TO THE APPROVAL.

2 CARING FOR A CAT CAN BE A 15 TO 20 YEAR COMMITMENT. THE FINANCIAL COMMITMENT OF OWNING A CAT IS $ ANNUALLY. ARE YOU WILLING AND ABLE TO MAKE THESE COMMITMENTS TO THIS CAT? PLEASE CONSIDER THESE COMMITMENTS CAREFULLY. YES NO PERSONAL INFORMATION 1) Do you currently live in a: House Apartment Condo Other 2) Do you currently: Own Rent Lease Live with parents/grandparents Live with friend Other the residents where you live? 3) How long have you lived there? 4) Are you planning to move in the next 6 months? Yes No 5) Previous address: 6) Length of time at previous address: 7) If you move, what will you do with the cat? 8) Landlord s Name Phone 9) Employer?Business How long? 10) How many adults live in the home? Ages:,, Names:,, 11) How many children live in the home? Ages:,,,, Names:,,,. 12)Does anyone in your household have allergies?yes No 13) Who will be primarily responsible for the care of this cat? 14) Name of reference not related or living with you: 15) Phone number of reference:

3 16) Which of the following best describes your reasons for wanting to adopt this cat? (Check all that apply) Companion Couch Warmer For Children Mouser Companion for a pet Other 17) Will this cat be: Indoor only Outdoor only Indoor&Outdoor 18) Where will the cat be kept when no one is home? 19) Where will the cat be kept at night? 20) How long do you plan to keep this cat? 21) What arrangements would you make if you no longer can keep this cat? 22) LONG TERM COMMITMENT. Which of the following would cause you to give up this cat? Job (working more, longer hours), New baby Kids, busy, not time for cat, Change in family status, Expensive vet care, Behavior problems, Moving, Other please explain 23) If you have other pets, are their vaccinations current? Yes No 24) Are they currently licensed with your county? Yes No 25) Are your pets on flea/tick preventative Yes No 26) Are your pets on heartworm preventative Yes No 27) Please list all the pets living at your residence: Breed, Sex, Altered, Inside/Outside Breed, Sex, Altered, Inside/Outside Breed, Sex, Altered, Inside/Outside Name, Type of Animal, Age, Breed, Sex, Altered, Inside/Outside

4 28) Name of your veterinarian 29) Phone Number of your veterinarian 30) Please list all the pets you have had in the last 10 years: Breed, Owned how long?, What happened to him or her? Breed, Owned how long?, What happened to him or her? 31) Have you ever adopted a pet from a shelter? Yes No When? 32) Have you ever relinquished a pet to a shelter before? Yes No When? Why? 33) Have you ever given a pet away? Yes No When? Why? 34) Have you or any member of your household ever owned an animal that has been confiscated by any animal control for violations of state or local animal control regulations or an animal adoption agreement? Yes No When? Why 35) Have you or any member of your household ever been subjected to legal action for cruelty or neglect of animals? Yes No When? Why? 36) You agree to provide basic medical vet care for this cat. Yes No If no, why? 37) You agree to provide rabies vaccinations according to Vermilion County Ordinance? Yes No If no, why? 38) You agree to maintain heartworm and flea/tick prevention all year long? Yes No If no why?

5 39) Do you have any objections to an inspection of your premises by VCDAR? Yes No 40) Do you understand the local ordinances concerning: Licensing, Rabies Vaccinations and leashing? Yes No I hereby release to the Vermilion County Animal Shelter all veterinary records of any and all animals I own and have owned. I certify that the above information is true and correct to the best of my knowledge. I also acknowledge falsification of the above can result in my being denied adoption of an animal or, if an animal has been adopted to me, the return of the animal to the Vermilion County Animal Shelter. Signature Date Approved by Denied by Reason