Submitted by admin on Sat, 03/10/2018 - 13:19 Cat's name you are interested in adopting. * What attributes are you looking for in a companion * Your name * Date of birth * Co-Applicants name Co-Applicants date of birth Address * Phone Numbers * Email Place of business/employment * Emergency contact and phone number * Referred by: * Are all family members in approval of bringing a new cat into the family and committed to at least a two week transition period? * Yes No Do you have children/grandchildren at your home, or are you expecting a child in the near future? * Yes No How many people live in your home? (Please list relation to you and ages) What experience do the children in your home have around cats? Type of dwelling: * - Select -HouseApartmentMobile HomeCondo/townhouseFarmDuplex/tripleOther You answered "other" for dwelling, please explain. How long have you lived at this address? * Less than 1 Year 1-5 Years 6-10 Years Over 10 Years What was your previous address? Do you own or rent your home? * Own Rent What is your landlords name and phone number? Are you planning to move in the near future? * Yes No What will you do with your cat when you move? What kind of cat do you want? * - Select -Inside CatOutside CatBoth inside and outside How long are you away from home daily? * - Select -Home all dayOut part timeAway 8+ hours/day Where will your cat be when.. When you are out of town or during an emergency * During the day? * At night? * When you are at work? * Who will mainly be responsible for this cat? * Are you a first time cat owner? * Yes No What do you think is a reasonable amount of time for a cat to adjust to a new home * What issues would compel you to give up this cat? * Scratching Litterbox issues Shedding Property damage Other None of the above You answered "Other", please explain. What methods will you use to teach your new cat? * How do you plan to transition this new pet in with your current pets? * Do you or anyone in your home have allergies? * Yes No What kind of allergies? Do you understand many people have allergies to cats? * Yes No Have the members of your household been checked for cat allergies? * Yes No For what reasons would you choose to euthanize a pet? * Do you understand ECHS has to right to deny an adoption for any reason they deem not to be in the best interest of the cat? * Yes No Your veterinarians name, address and phone number * Please list pets you currently have NameType/BreedAgeHow long ownedMale/Female - Spayed/NeuteredStays Indoors/Outdoors Name Type/Breed Age How long owned Male/Female - Spayed/Neutered Stays Indoors/Outdoors Add Pet List pets previously owned in the past 10 years NameSpecies/BreedHow Long OwnedKept Indoors/OutdoorsSpayed/NeuteredWhere is pet now? Name Species/Breed How Long Owned Kept Indoors/Outdoors Spayed/Neutered Where is pet now? Add a pet I certify that the information I have provided is accurate and that any misrepresentation of facts may result in my losing the privilege of adoption a cat through ECHS. As ECHS is a charity depending solely on donations and service fees, I understand that if a cat is placed with me I will pay a NON-refundable adoption fee. However, If I find I am unable to care for the cat, for any reason, ECHS will accept the cat back. I understand * Yes No Leave this field blank Submit
