Crossroads Animal Rescue - Applicant Information Form

Name of Cat:
Breed:
Date:
Name:
Spouse:
Address:
City:
State:
Zip Code:
Home Phone #:
Work Phone #:
Cell Phone #:
Email Address:
Type of Residence:	House
	Apartment/Condo
	Townhouse
	Mobile Home
Own or Rent?	Own Rent
	Complex Name: What is your landlord’s pet policy? (Documentation may be required before adoption is finalized)
Location:	Urban Suburban Residential Rural On Acreage
How many household members?
List ages of any children under 18 (N/A if none):
Are you or another member of your household presently employed?	Yes Employer:
	No
	Unemployed Retired Student
Current/Past Vet Clinic:
Vet Phone #:
Have you owned any pets within the last ten years?	Yes
Have you owned any pets within the last ten years?	No

Where will the cat live?	Inside Outside Mostly Inside Mostly Outside
Where will the cat spend nights?	Inside Outside
Where will the cat stay when left alone at home?	Inside Outside
Do you plan to declaw the cat anytime in the future?	Yes No I might
If the cat is living mostly or partially outdoors, what monthly preventatives will you be using?	Monthly Flea/Tick Preventative Monthly Heartworm Preventative I won't be using any I'm not sure what this is

Q1. Why are you choosing to adopt a cat?

Q2. What is your understanding of the routine veterinary care necessary to maintain a healthy animal?

Q3. If you have plans to go out of town or on vacation, what will you do with your cat?

Q4. If you had to move or your circumstances changed, what would you do with your cat?

If you have any additional information you would like for us to consider or any comments, include here: