Pippi's Place Cat Adoption Application

Please complete our adoption application and we will process as soon as possible. The questions marked with a red asterisk are mandatory, but we ask that you try to answer all the questions if possible.

For your privacy, Pippi's Place keeps all personal information confidential and will not share your info with anyone.

Questions? Please contact us.

About You
Please enter your full legal name
Title For example: Mr., Mrs., Ms
First Name * Your first name
Middle Name
Last Name * Your last name
Your Date of Birth * MM/DD/YYYY

Name of pet you would like to adopt Select if known
Would you like to adopt a second cat/kitten (littermate/bonded pair)?	Yes No

Name of second pet
Please enter at least one phone number below *
Home Telephone
Work Telephone
Cell Phone

Email Address *
Work/Occupation *
Employer *
Your residence
Street Address *
City *
State *
Zipcode *
Co-applicant for this Adoption (if any)
Is there a co-applicant ?	Yes No
Co-Applicant Name
Your relationship to the Co-Applicant For example family, friend, roommate
Co-Applicant Work/Occupation
Tell Us About Your Home
Do you live in a:	House Town House Appartment Condo

Do you own or rent your home ? *	Own Rent Other

Landlord's Name *
Landlord's Phone Number *
Landlord's Email Address
Landlord's Mailing Address * Enter street, city, state and ZIP
About Your Household
HUMAN Household Members
List HUMAN household members, ages, pet responsibilities
Do all adults work outside of the home full time?	Yes No

Is anyone in your home allergic to pets?	Yes No

Are you or anyone in the household a smoker?	Yes No

Does everyone in your home know that you are interested in bringing another animal into the home?	Yes No
ANIMAL Household Members
Please list your ANIMAL household members (Age, breed, sex, spayed/neutered, and date of rabies vaccination). Please include any that have passed within the last 12 months.
List the temperament of the cat(s) in your house, if you have any cats.

Are your current pets spayed and neutered?	Yes, all No, none Some

Have you ever declawed or would you consider declawing a cat?	Yes No

How many pets have you owned previously? *
Cat Wellness
Why do you want to adopt a pet? Select all that apply

Are you adopting a pet to live:	Inside Outside Inside/Outside

Have you ever had to relinquish a pet?	Yes No
Please explain
Describe the type of situation where you might have to give up the cat
For which of the following reasons would you consider giving up your cat? Check all that apply. * Select all that apply

What do you think are the most important responsibilities in owning a cat?
Training
What behaviors are you not willing to tolerate from a pet?
How will you correct these behaviors?
What do you do with your cat when you are out of town?
Pet Safety
Where do your pets spend most of their time?	Inside Outside
Where will your pet sleep?
How many hours per day would your cat be left alone?
Where will your pet stay when home alone?
Cat Health
Are you prepared to care for a pet for up to 15 years?	Yes No Can't be sure

How much money are you able/willing to spend if the pet becomes sick or injured?	$500 or less $1,000 or less Whatever it takes to provide appropriate care

What brand/type of food are your current pets, or will your future pet be eating?
Are/will your pets be regular on: Select all that apply

Are you willing to let a Pippi's Place representative come for a home visit before or after adoption?	Yes, with notice No
Veterinarian Information
Your veterinarian's name
Your veterinarian's phone
May we call your vet to confirm your pets are altered and vaccinated?	Yes No
References Can you please provide us with two personal references?
Name and phone or email for first reference *
Name and phone or email for second reference *
What else should we know ?
How do learn about us?
Where did you first see this pet(s)? Select one

Do you visit our website?	Yes No

Do you follow us on facebook?	Yes No

Comments

Pippi's Place Cat Adoption Application

About You

Co-applicant for this Adoption (if any)

Tell Us About Your Home

About Your Household

HUMAN Household Members

ANIMAL Household Members

Cat Wellness

Training

Pet Safety

Cat Health

Veterinarian Information

References

How do learn about us?