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
Boots (Cat - 2024-9-4)
Eleanor (Ella Mae) (Cat - 2022-7-24)
Emily (Emily Grace) (Cat - 2022-7-25)
Howie (Cat - 2022-8-8)
Jojo (Cat - 2024-9-17)
Lexi (Cat - 2024-6-24)
Rhys (Cat - 2024-9-5)
Riki (Cat - 2024-9-14)
Riley James (RJ) (Cat - 2024-9-7)
Rosie (Cat - 2024-9-12)
Ruby (Cat - 2024-9-6)
Snuggles (Cat - 2024-9-15)
Tavi (Cat - 2024-9-16)
Terry (Cat - 2022-8-11)
Tigger (Cat - 2024-9-8)
Would you like to adopt a second cat/kitten (littermate/bonded pair)?
Yes
No
Name of second pet
Boots (Cat - 2024-9-4)
Eleanor (Ella Mae) (Cat - 2022-7-24)
Emily (Emily Grace) (Cat - 2022-7-25)
Howie (Cat - 2022-8-8)
Jojo (Cat - 2024-9-17)
Lexi (Cat - 2024-6-24)
Rhys (Cat - 2024-9-5)
Riki (Cat - 2024-9-14)
Riley James (RJ) (Cat - 2024-9-7)
Rosie (Cat - 2024-9-12)
Ruby (Cat - 2024-9-6)
Snuggles (Cat - 2024-9-15)
Tavi (Cat - 2024-9-16)
Terry (Cat - 2022-8-11)
Tigger (Cat - 2024-9-8)
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
Companion for me
Companion for another pet
Family Pet
Child's Pet
Mouser
Gift
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
Moving
Fights with other pets
Not housebroken
Divorce
Behavior issues
No reason I would give up my pet
Medical issues
Allergies
Kids no longer want
Financial problems
Messes up the furniture
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
Heartworm prevention
Flea/tick prevention
Annual vet checks
None
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
Pippiās Place website
Petfinder
Adopt-A-Pet
Other Website
Facebook
Instagram
TikTok
Howell Mill Adoption Center
Previous adopter
Referred by family member or friend
Do you visit our website?
Yes
No
Do you follow us on facebook?
Yes
No
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