Name: _________________________ Date of Birth:____________________
Address: ________________________________________________________
City: _____________________ State: __________________ Zip: _________
Phone: _________________________
E-Mail Address: _________________________________________________
Do you Rent or Own (Circle one)
If you rent please provide your landlords name and phone number:
__________________________________
__________________________________
Are you over the age of 18? __________________________________________
If you are between ages 18-21, do you live outside your parents home? ________
(If no, you parent must sign your adoption contract also, as the animal will
be living in their home.)
* Vet name: __________________________________
Address____________________________________
Phone:_____________________________________
* Animal Control in your City (agency and phone number):
__________________________________
__________________________________
* Does the city in which you live require you to license pets? ___________
If so, what is the cost of a pet license? _______________________
What is the fine if your pet is not licensed? ___________________
1. Why do you want a special needs cat? ______________________________________
______________________________________________________
______________________________________________________
2. How many adults are in your household? ________________________
How many children (please list ages) ________________________
______________________________________________________
Does everyone in you household agree to the adoption of a special needs cat?
______________________________________________________
3. Do you have any other pets at home? ____________________________
If so, what kind and how many _____________________________
_______________________________________________________
_______________________________________________________
Do you know and understand the specific risks, if any, a cat with this special need
Could pose to your current pets? ____________________________
_______________________________________________________
_______________________________________________________
4. Are all of your pets current on their vaccinations? __________________
Do you understand that this special needs cat may require special vaccines?
_______________________________________________________
*5. How often are your animals home alone?
_________________________________________________________________
_________________________________________________________________
Do you understand that this special needs cat may be on a medication schedule
That requires someone to be there at certain times? _______________________
Do you have reliable contacts to take care of this cat, and it’s special needs, when
You are away on vacation or called away to an emergency? ________________
6. Have you ever had a pet die in your care? ___________________________________
If so, what was the cause of death? ____________________________________
_________________________________________________________________
7. What areas of the house will the cat be allowed in? ___________________________
_________________________________________________________________
8. How do you plan to train your cat as to what behaviors are and aren’t acceptable?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
* 9. Who will care for your animals, or what will you do with your animals in the event
that you are unable to care for them? ___________________________________
_________________________________________________________________
_________________________________________________________________
10. Do you believe in letting cats outdoors? ___________________________
Why or why not? __________________________________________
________________________________________________________
11. Do you believe in declawing cats? _______________________________
Why or why not? _________________________________________
12. If you have other pets at home, how will your new cat be introduced? ____________
______________________________________________________________________
______________________________________________________________________
* 13. What safety precautions have you taken to ensure your home is “cat proof”?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
14. What do you plan to feed your cat? _______________________________________
* 15. Do you understand the disability that this cat has, and do you understand that there is a
possibility that this cat could incur medial costs not common to healthy shelter animals? Please
detail below any research or experience you have with cats with this disease or disability.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
* Information noted with an asterisk (*) is requested not so we can check up on you, but so
that we can be assured that you have fully thought through your decision to adopt a cat, and that
you have a plan of action to follow if an accident does happen and your pet is injured, becomes
sick, or escapes. Even if you are not currently a pet owner, please take the time to find out
about, or think about, these things before you submit your application. If you are a pet owner,
ask questions… you may learn something you never knew!
| Kitties from Heaven |
| Special Needs Adoption Application |
| Thank you for your interest! Please return application to: Kitties from Heaven 101 Edgewood Dr Webster City, IA 50595 (253)912-2089 or katie@kittiesfromheaven.com |
C 2007 Kitties From Heaven