Cat Adoption Form - Janine The Bean Rescue

* indicates required field

Are you applying to

Adopt Foster

Cat's Name (or type of cat):

Please let us know what attracted you to this cat or what you are looking for in a cat?

Your First and Last Name*

Address

City, State, and Zip Code

Preferred Phone Number

Occupation

Employer

Email:*

How many adults in household?

Number and ages of children

Are all adult members of the household in agreement about adopting or fostering?

Yes No

Who will be responsible for the pet?

Maximum number of hours pet will be left alone daily?

Are any household members allergic to pets?

Yes No

Are you moving in the next 12 months?

Yes No

Do you own or rent your home? If renting, please list name and phone number of landlord below

Rent Own

Landlord Name

Landlord Phone Number

If you have other cats, list age and gender of each

Are they spayed/neutered?

Yes
No
Doesn't apply, no other cats

Are they declawed?

Yes
No
Doesn't apply, no other cats

Are they up-to-date on vaccinations?

Yes
No
Doesn't apply, no other cats

If not, why?

Do they go outside?

Yes
No
Doesn't apply, no other cats

If so, how often?

If you have dogs, list age and breed of each

Are they spayed / neutered?

Yes
No
Doesn't apply, no dogs

Up-to-date on vaccinations?

Yes
No
Doesn't apply, no dogs

If not, why?

Have you had other pets in the past five years?

Yes No

If so, for how long and what happened to them?

Will you be declawing your new cat?

Yes
No
Undecided

Would you like information on declawing?

Yes No

Will your new cat be allowed to go outside?

Yes No Undecided

Please list names and phone numbers of all the veterinarians you've taken pets to within the past 2 years. (Please call the office(s) to release your pets records to us.)

Have you applied to adopt or foster a pet through Us or any other rescue organization within the past 2 years?

Yes No

Have you ever surrendered an animal to a shelter or rescue group? If so, please explain

Would you agree to a home visit by one of our volunteers?

Yes, I agree.
No, I do not agree.

Comments or Additional Information:

By checking this box and submitting this form, I hereby certify that all statements are true to the best of my knowledge and my submission acts as my signature. I further understand that Janine the Bean Rescue reserves the right to approve or deny all applications.

CAPTCHA Code:*