test form 2 - Janine The Bean Rescue

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

Number and ages of children

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

Yes No

Maximum number of hours pet will be left alone daily?

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

Rent Own

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

Do they go outside?

Yes
No
Doesn't apply, no other cats

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

Have you had other pets in the past five years?

Yes No

Will you be declawing your new cat?

Yes
No
Undecided

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.

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.