Southern Counties Rescue ~ Adoption Application

We foster our cats in our homes with our own pets and family so we know their personalities.

Thank you very much for taking the time to complete the application. I would appreciate it if you answer every question. Please give as much detail as possible, providing phone numbers and appropriate contact persons where requested. You must be 23 years of age or older to adopt. Completion of the application doesn't guarantee adoption.
All cats are spayed/neutered, microchipped, current on vaccinations, tested for FELV/FIV, dewormed and flea free.
Driver's License information will be requested when you adopt. Please have your driver's license with you.

Date: * +

If applying for a specific cat what is the cat's name? If not, is there a breed or "look" you want? * 🛈

Applicant name & spouse/significant other: *

Street Address: *

City: *

State *

Zip Code *

List home Phone *

List cell phone *

Person 2 cell # * 🛈

Best to Call *

Email address person 1: *

Email address person 2:

Email: *

List any additional people living with you and their relationship to you *

Has anyone in the household experienced allergies or asthma? * 🛈

No

Minor

Yes: Yes:

Ages of children *

Occupation(s) of Applicant(s): *

Name and age of primary caretaker of the cat: *

What is the primary reason(s) for adopting this cat? *

Do you live in a: *

Do you own or rent? *

How long have you lived at this address? *

Landlord's permission to have a pet? *

Landlord's name & phone number" *

Do you object to a home visit? *

No

Yes

Will this cat be: *

If outdoor access, explain circumstances & how long:

Please: *

Check if you have a balcony	Check if all windows have screens
Check if you have a screen door	Check if you have screens on sliding doors
Check if you have a patio	Check if you have screens on French Doors
Check if any window screens are broken or missing

Do you have a dog door? *

Do you have French Doors? *

If you had a cat in the last 5 years, what did you feed?

About how many hours of the day will your cat be left alone & where will he be left (be specific)? *

Will pet be allowed on furniture? *

Where will you keep the litter box? *

What areas of the house will be off limits? *

Do you have a limit on the cost of vet treatment? *

Yes

No

Depends on: Depends on:

How much is too much? *

Your Veterinarian’s name and city where located: *

Vet's phone number: *

List all cats you have now & in the past 10 years. If no cat, enter "none" in cat name.

Cat 1 Name: *

Age:

Sex:

Spay/Neutered:

Declawed:

Breed (or description), personality and has it been with other cats?

0/250 characters

Where did it come from?

Name of Rescue Organization: 🛈

Tested for FeLV & FIV, Was the test result pos or neg?

Yes

No

Results? Results?

Access to?

If declawed, where?

Still Own? *

Yes

No

If no, why do you no longer have this cat? If deceased, from what? *

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Cat 2 Name:

Age:

Sex:

Spay/Neutered:

Declawed:

Breed (or description), personality and has it been with other cats?

0/250 characters

Where did it come from?

Name of Rescue Organization: 🛈

Tested for FeLV & FIV, Was the test result pos or neg?

Yes

No

Results? Results?

If declawed, where?

Access to?

Still Own?

Yes

No

If no, why do you no longer have this cat? If deceased, from what? *

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Cat 3 Name:

Age:

Sex:

Spay/Neutered:

Declawed:

Breed (or description), personality and has it been with other cats?

0/250 characters

Where did it come from?

Name of Rescue Organization: 🛈

Tested for FeLV & FIV, Was the test result pos or neg?

Yes

No

Results? Results?

If declawed, where?

Access to?

Still Own?

Yes

No

If no, why do you no longer have this cat? If deceased, from what? *

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Cat 4 Name:

Age:

Sex:

Spay/Neutered:

Declawed:

Breed (or description) and personality?

0/250 characters

Exposure to Other Cats:

Where did it come from?

Name of Rescue Organization: 🛈

Tested for FeLV & FIV, Was the test result pos or neg?

Yes

No

Results? Results?

If declawed, where?

Access to?

Still Own?

Yes

No

If no, why do you no longer have this cat? If deceased, from what? *

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Additional Cats: enter about each - names, sex, age, declawed, personality, where now, if deceased, cause of death?

0/250 characters

List all dogs you have now & in the past 10 years. If no dog, enter "none" under dog name.

Dog 1 Name: *

Age:

Sex:

Spay/Neutered:

Size:

Breed: 🛈

Purebred:

Exposure to Cats:

Access to? 🛈

Where did it come from?

Name of Rescue Organization: 🛈

Personality?

0/250 characters

Still Own? If no, why do you no longer have this dog? If deceased, from what?

Yes

No

Why no longer? Why no longer?

Dog 2 Name:

Age:

Sex:

Spay/Neutered:

Size:

Breed: 🛈

Purebred:

Exposure to Cats:

Access to? 🛈

Where did it come from?

Name of Rescue Organization: 🛈

Personality?

0/250 characters

Still Own? If no, why do you no longer have this dog? If deceased, from what?

Yes

No

Why no longer? Why no longer?

Additional Dogs: enter about each - names, sex, age, personality, where now, if deceased, cause of death?

0/250 characters

-------------------- General Information ----------------------

Were you ever in a situation where you were not able to keep a pet? If yes, please explain: *

0/450 characters

Do you travel often? Who would take care of your pet when you travel? *

Yes

No

Caregiver: Caregiver:

What will you do if your cat claws the drapes or furniture? *

Do you want to declaw this cat? *

Yes

No

Maybe

Why? *

Are you able to talke care of this cat for its entire life (cats can live 15-20 years)? *

Yes

No

If you are unable to care for the cat who will take it? Name/Phone number/Relationship *

Did you or your spouse/significant other grow up around cats? *

Both of you? *

Do you expect any major changes in your life in the next five years? *

Yes

No

Highly unlikely

If yes, please check what they might be:

Under what circumstances would you not be able to keep this new pet? (Please check all that apply) *

Please provide any additional information you want to share.

THIS APPLICATION BECOMES PART OF OUR CONTRACT:

I certify that all the above information is true and accurate. I understant that if I adopt a pet from Southern Counties Rescue, this document will become part of the adoption record.

Date: * 🛈 +

Signature: *

Please email me updates

Thank you for completing this Application. Someone should get back to you within 2 days. If you do not hear from someone please email soCountiesRescue@att.net. Please remember we are all non-paid volunteers with other jobs.

Companion for pet	Companion for children	Companion for me/us
Replace lost/deceased cat	gift for friend/family (outside your home)	Other (explain): Other (explain):

Move out of state	Move overseas	Get married
Change career	Have baby or adopt	Acquire roommate
Increase travel	Decrease travel	Downsize home
Move to larger home	Training/Schooling	Other Other

Personal changes for you	Divorce/Separation
New Spouse	Pregnancy
New Baby	New roommate
New Allergy	Job change/loss
Disability/Illness	New house/apt.
New carpet/drapes/furniture	Cat's Behavior Problems
Kids too rough with pet(s)	Cat too rough with kids
Does not get along with other pet(s)	Sprays, does not use litter box
Keeps you awake	Scratches carpets, drapes, furniture
"Talks” too much	Needs too much attention/time
Taking too long to adjust to family (over 4 weeks)	Cat's general health problems
Cat incurs expensive vet bills	Requires daily medical treatment
Needs special diet	Cat becomes disabled
None of the above (please don't check this lightly)	Other reasons (explain) Other reasons (explain)