MomaKat Rescue Adoption Questionnaire
Application for Adoption
Email address *
Full Name (First & Last) *
Date of Birth *
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Current Address (Street, City, State & Zip Code) *
Primary Phone # *
Alternate Phone #
Email Adress *
Do you rent or own? *
If you rent, provide the name of your landlord & their phone #.
Do you have plans to move within the next year? *
What kind of residence do you live in? *
If you have lived at your current residence for less than 2 years, list the prior addresses within the past 2 years.
Occupation *
Name of Employer & # of years with that employer. *
Are you a student? *
If you are a student, list the name of your school.
How many people live in your home & their ages? *
Will the kitty reside with you at your current address? *
If you answered sometimes, list the address & with whom the kitty will also stay.
Who will be financially responsible for the kitty? *
Who will be responsible for the kitty's care? (feeding, cleaning litter box, brushing, etc) *
Where will your new kitty stay? *
Do you have any pet doors? *
If you have pet doors, list how many.
How many hours on an average day will your cat be left alone? *
Where will the kitty stay when left alone? *
Have you or anyone in your household experienced allergies to cats or asthma? *
Are all members of the household in agreement with adopting a kitty? *
Why are you looking to adopt a kitty? *
Name of Current Veterinarian Clinic *
Vet's Phone # *
If your relationship with your current vet is less than 2 years, please list your previous vet clinic & phone #. *
What is your price limit on vet expenses per visit? (for routine visits & emergencies) *
Do you agree to grant permission for the current & previous veterinary offices to discuss information related to your pet ownership & care with a Momakat Rescue representative? *
Do you currently have any other pets? *
If yes, list your current pet(s) including the type of pets, their ages & how many. *
If you have pets, have they all been around other cats? *
How many cats have you had (as an adult)? *
Have any of your pets gone missing or died within the last 5 years? *
If you answered yes above, provide the circumstances.
Have you ever surrendered a pet? *
If yes, where did you surrender the pet?
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If you surrendered a pet(s), what were the circumstances?
Do you plan to declaw the kitten(s)/cat(s) you adopt from Momakat Rescue? *
Are you prepared for common behavior issues such as scratching, nibbling, litter box accidents, etc? *
If yes, what methods will you use to correct the behavior issues? *
If you are away from home for an extended period of time, what is your care plan for your pets? i.e. vacation *
Are there any circumstances that could cause you to give up the kitten(s)/cat(s) you adopt from Momakat Rescue? *
Would you consent to a pre-adoption and/or post-adoption home visit? *
List the name of the kitten/cat you are interested in adopting.
Please list any additional information you think we should know.
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 contract. (Type full name below for signature) *
Date of Signature *
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A copy of your responses will be emailed to the address you provided.
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