Cat Adoption Form - Janine the Bean Rescue

Please fill out the below form to apply for adopting a Cat

## PLEASE BE AWARE THAT WE ARE NOT CURRENTLY ABLE TO ADOPT A CAT TO ANYONE LIVING MORE THAN ONE HOUR AWAY FROM ROCHESTER, NY ##

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Are you applying to? *
Cat's name (or type of cat) *
Please let us know what attracted you to this cat or what you are looking for in a cat? *
Your First and Last Name *
Address *
Phone number *
Email *
Employer
How many adults in household?
 *
Number and ages of children (If no children, enter None) *
Are all adult members of the household in agreement about adopting or fostering? *
Who will be responsible for the pet? *
Maximum number of hours pet will be left alone daily? *
Are any household members allergic to pets? *
Are you moving in the next 12 months? *
Do you own or rent your home? If renting, please list name and phone number of landlord below *
If renting, please list name of landlord's name below *
If renting, please list landlord's phone number below *
If you have other cats, list age and gender of each (If no other cats, enter None.) *
Are your cats spayed/neutered? *
Are your cats declawed? *
Are your cats up-to-date on vaccinations? *
If your cats are no up-to-date on vaccinations? why? *
Do your cats go outside? *
If your cats go outside, how often? *
If you have DOGS,  list age, breed and gender of each (If no dogs enter None.) *
Are your DOGS up-to-date on vaccinations? *
If your dogs are no up-to-date on vaccinations? why? *
Have you had other pets in the past five years? *
If yes,  for how long and what happened to them? *
Will you be declawing your new cat? *
Would you like information on declawing? *
Will your new cat be allowed to go outside? *
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? *
Have you ever surrendered an animal to a shelter or rescue group? If so, please explain *
Do you smoke? *
Would you agree to a home visit by one of our volunteers? *
Comments or Additional Information:
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. *
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