Kitten/Cat Name: black line Description: black line

New Home

Name:
First:black line Last:black line
Address:  black line
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City: black line
State: black line
Zip: black line
Home phone: black line
Work phone: black line
Cell phone: black line
Email: black line
How long have you been at this address? black line
Do you own or rent your home?
Own
Rent
  Landlord's name: black line Landlord's phone: black line
Pets allowed?
Yes
No
How heavy is traffic on this street?
Light
Medium
Heavy
Do your windows have screens?
Yes
No

Environment

How many adults in the home? black line How many children? black line Ages of children? black line
Does anyone in the home have allergies to cats?
Yes
No
Does anyone in the home smoke?
Yes
No
What pets do you currently have? Please include their ages and how long you have had them.
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How many hours a day will the cat(s) be alone? black line
Where will the cat(s) be when alone? black line
Where will the cat(s) be when you are at home during the day? black line
Where will the cat(s) be when you are home at night? black line

Pet Care

Who provides veterinary care for your pets? black line Phone: black line
Who will be primary caretaker for the cat(s)? black line
How often does the primary caretaker travel? black line
Who will take care of the cat(s) in an emergency or during vacations? black line

Experience

What pets have you had previously? Please include their ages and how long you had them.
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What happened to them?
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Have you ever lost a pet or had one run away?
Yes
No
Have you ever had a pet hit by a car?
Yes
No
Have you ever had a declawed cat?
Yes
No
Have you ever surrendered a pet to a shelter?
Yes
No
Please explain why you surrendered the pet.
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Have you ever nursed a sick animal?
Yes
No
Please describe the illness and the care provided.
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Comments

Is there anything else you want to tell us about yourself or the place the cat(s) will be living?
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Feedback

Have you attended a Bay Area Cat Rescue Adoption Fair?
Yes
No
How did you hear about the adoption fair? black line
Had you already decided to adopt a kitten/cat before attending the adoption fair?
Yes
No

Signature

I certify that the above information is true and understand that misrepresentations may result in the cancellation of the adoption. In providing a veterinarian reference, I am authorizing the veterinarian to disclose information to BACR.
Signature: black line
Date: black line