Name *

First Name

Last Name

Date of Birth

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Day Phone #

(###)

###

####

Evening Phone #

(###)

###

####

Best Time to Call

Hour

Minute

Second

AM PM

Do you rent or own?

Rent

Own

If you rent, may we contact the owner to obtain permission for this animal to live in your home? *

Yes

No

If less than one year at present address, please provide previous address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Did you rent or own?

Rent

Own

Is this pet for yourself?

Yes

No

Are you 21 years of age or older?

Yes

No

Does anyone in the house have allergies?

Yes

No

If you move, will you take this pet with you?

Yes

Yes, if landlord allows

No

Not Sure

Have you owned a pet in the last 5 years that is not listed above?

Yes

No

Current vet's name:

First Name

Last Name

Vet's Phone #:

(###)

###

####

Can your vet verify current history on your present pets? *

Yes

No

If the cat you listed has already been adopted, are you interested in adopting another cat? *

Yes

No

I want this cat to be a:

Barn Cat/Mouser

Gift

Child's Pet

Household Campanion

Companion for another pet

Breeder

Other

Have you turned animals into a shelter before?

Yes

No

Have you adopted from Feline Friendz before?

Yes

No

Have you adopted from a shelter or pound before?

Yes

No

Are you aware of your local ordinances in regards to cats?

http://www.omaha-douglasconnection.com/images/stories/38257DangerousDogs.pdf

Yes

No

Will this cat share a litter box?

Yes

No

Are you willing to add an additional litter box if needed?

Yes

No

Will you keep the animal up-to-date on vaccinations?

Yes

No

Are you willing to take responsibility for this pet for the next 10 to 15 years?

Yes

No

Do you plan to have this pet declawed? *

(i.e. An elective onychectomy or tendonectomy)

Yes

No

Would you be willing to allow a representative of Feline Friendz to do a home visit? *

Yes

No