MomaKat Rescue Adoption Questionnaire
Cat/Kitten name(s) you are interested in adopting. *
Your answer
How did your hear about MomaKat Rescue? *
Your answer
Your Name (First & Last) *
Your answer
Occupation *
Your answer
Name of employer *
Your answer
Birth date *
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Primary phone # *
Your answer
Alternate phone # *
Your answer
Home address (Street, City & State) *
Your answer
Email * *
Your answer
Have you adopted from MomaKat Rescue before? *
Name of spouse or significant other *
Your answer
How many people live in your home? *
Your answer
Do you have children? * *
Your answer
List any additional people in the household * *
Your answer
Who will be responsible for the cat's care (the primary caretaker)? i.e Feeding, cleaning litter box, taking cat to vet, etc *
Your answer
Have you or anyone in your household experienced allergies or asthma? *
Are you prepared to care for this cat for 20+years? *
Why are you looking to adopt a cat? Check all the apply *
Required
What kind of home do you live in? *
Required
Do you rent or own your home? * *
Your answer
Do you have plans to move in the near future? *
Do you have any of the following at your home? Check all that apply *
Required
How many hours a day will your cat be left alone? *
Your answer
Will your new cat be an indoor or outdoor pet? *
Is this your first cat/kitten? *
Do you currently have any other pets? *
List your current pet(s) including type of pets, their ages & how many. *
Your answer
What pets have you previously owned? *
Required
Do you plan to declaw your new cat? *
Name of current veterinarian clinic *
Your answer
Vet's Phone # *
Your answer
What is your price limit on vet expenses per visit? (for routine visits & emergencies) *
Your answer
Is there a cat behavior that would not be acceptable to you? * *
If answered yes, explain the behaviors that are unacceptable. *
Your answer
Were you ever in a situation where you were not able to keep a pet? *
If answered yes, explain why you were unable to keep a pet. *
Your answer
Please list any additional information you think we should know?
Your answer
I certify that all of the above information is true and accurate. I understand that if I adopt a pet from MomaKat Rescue, this form will become part of the adoption record. (Type Full Name Below for Signature) *
Your answer
Date of signature * *
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