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Full Name:
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Phone Number:
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E-mail Address:
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Home Address:
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City:
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State:
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Zip Code:
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Date of Birth:
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Occupation:
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Work Phone:
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Employer:
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Marital Status:
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Do you have any Children:
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If you have children, how many and what ages are they?:
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Are there any other individuals living in the same household? Names and ages:
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Does anyone have allergies or asthma that would be aggravated by a pet?:
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Have you ever owned a pet before? What kind?:
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What happened to your previous pet(s):
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Are there any other pets? Type, Breed, Age, Gender:
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Are any of your pets current on their vaccinations? If not, why not?:
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Are any of your pets spayed/neutered? If not, why?:
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Name and phone number of your past or present veterinarian:
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Do you rent or own? If renting, name and number of your landlord:
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Have you discussed adopting a pet with your landlord and been approved to have a pet? (If this does not apply to you, put does not apply. This would ONLY not apply if you OWN your house.):
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Where will the cat stay during the day and at night?:
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| Do you travel or go out of town a lot? If so what do you plan on doing with your animals while you are away?: |
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Have you discussed adopting a pet with your family? Is everyone in agreement about adopting?:
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Would you have the cat declawed?:
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Name of cat(s) your are interested in:
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| Have you ever been charged with cruelty to animals or been in jail before? If so please explain: |
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| Would you be OK with LBL Animal Rescue running a background check to make sure that all of the above information given is correct?: |
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Signature:
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Date:
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