SJRAS CIA Cat Questionnaire

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#1 Animal Name of Interest
#2 Animal Name of Interest
Have You Ever Had a Barn/Outdoor Cat Before? *
Last Name *
First Name *
Your Home Street Address *
City *
State *
Zipcode *
Municipality * Most of the time this will be the same as your city, but can be different if you have a mailing address in the nearby major city but actually live in a smaller borough or township. (example: If you live in Hopewell Township but have a Bridgeton mailing address)
County *
Email Address *
Home Telephone
Mobile Telephone
Work Phone
Best Way to Reach You? *	Cell Home Work
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CIA Location Information
Property Where Your CIA Agent Will Work (if different than above) *
City
State
Zipcode
County
Municipality
Does Anyone Live at the Property? *
In Regard to This Property, Do You *	Rent Own Live with Parents Other (explain below)
If You Selected "Other" Above Please Explain
If You Selected "Rent" Above, Name of Your Landlord/Mgmt Company
Your Landlord/Mgmt Co Phone Number
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About Your CIA Working Cat's Environment
Please Describe The Area Where Your CIA Agent(s) will be living (type of shelter, land area, general information) *
Do You Currently Have Other Cats That Share This Shelter? *
Are There Other Animals That Have Free Access To This Area? *
Do You Have The Necessary Supplies/Room To Keep The Cat Confined Until It Acclimates to It's New Surroundings? *	Yes No I'm Not Sure, I Need More Information
Types of CIA Agents You Would Like to Hire: (check all that apply) *
Are You Aware of Oridinances/Regulations in Your City/Township Pertaining to Cats (Licensing Requirements, Number Limits, Free Roaming Restrictions, etc.) *	Yes No I Need to do More Research, but will do this before I hire a CIA Agent
Is there any other information you would like to share with us regarding employing a CIA Agent?
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Now All the Legal Mumbo Jumbo Our Lawyers Tell Us We Have to Include
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We reserve the right to refuse any adoption. A refusal may not indicate any shortcomings on the part of the prospective adopter, but perhaps reflects that a particular pet may not do well in the circumstances offered. Our years of experience and information from national organizations such as HSUS and AHA are our guide in arranging a successful adoption.
By hitting the SUBMIT button below I certify that I am at least 18 years of age. I also certify that all information given by me in this application is true & complete. I further understand that any falsified information that I give will terminate action on the adoption process. I certify that I understand that SJRAS will NOT be able to contact me to update the status of my adoption. By Checking this box I authorize release/disclosure of records and/or other information concerning all of the above inquiries (including but not limited to employment, tenancy & veterinary records. I am aware that in order to follow up with my adoption I must contact the SJRAS office within 24-48 hours after submitting this application.
Having a CIA Agent on Your Property Requires Certain Standards to be Upheld. Please Read the CIA Cat Information Page. (This page will open in a new window so as to not inturrupt your completing the hiring form)
I Have Read & Understand the CIA AGENT Information Page & Agree That Providing Proper Sustinance, Shelter, and Medical Care Will Be My Responsibility *
In order to avoid confusion or misunderstanding we ask that you read the Adoption Process & Illness Information. This document will open in a separate window so as to not interrupt your completing the questionnaire.
I understand that I should read & understand the ADOPTION PROCESS & ILLNESS Information *
Signature (if on a compatible device)
<--------------------All Items Below This Line For SJRAS OFFICE STAFF USE ONLY----------------------->
ASM Complete Date: CC Complete Date: Tax Complete Date: O - - - - R - - - - -OTHER LL Ok'd Date: RestrictionsIndicated:
Processing Notes:
Date: Counselor: Session Notes:

SJRAS CIA Cat Questionnaire

CIA Location Information

About Your CIA Working Cat's Environment

Now All the Legal Mumbo Jumbo Our Lawyers Tell Us We Have to Include