Pacific Cat Clinic / APPLICATION FORM (Preliminary)

Form - PRELIMINARY Adoption Application

Who Will Be The Primary Owner Of Your Cat?
First Name	Last Name

Daytime Phone #
Phone Type	Phone Number

Evening Phone #
Phone Type	Phone Number

Other Phone #
Phone Type	Phone Number

Address
Street Address


City	State/Province	Zip/Postal Code
,

Occupation

E-Mail Address :

References

Please provide Pacific Cat Clinic with the names and contact numbers of two personal references

Information about your household and previous experiences with pets

Other family/household members, including contact information

Do you have other pets at home? If so, how many and what kind?

Does anyone in your home suffer from allergies? If so, what are they allergic to?

Who is your previous veterinarian?

Have you ever adopted a cat from Pacific Cat Clinic before? Who and when?

How did you hear about our adoption program?

Which Kitten do you want to adopt and why?

Lifestyle

Will the kitten have access to outdoors?
Never
Only when supervised or on a leash
Only on a deck, balcony or enclosure
Free access to outdoors
Will live outside/ in a barn

Where will the kitten sleep?
With me or another family member
Will have its own bed
Will sleep in the basement/garage/outside

Fees
Deposit: In order to secure a particular kitten, we require a deposit fee of $100. Once your application has been approved, and your fee received, we will hold that kitten for you until the appropriate age. This fee is non-refundable. Balance: At the time you pick up the kitten, you will be required to pay the balance of the fees due. You may arrange to do this by pre-authorized credit card payments.

The verification code below ensures the form is not submitted by a computer

Verification Code :

Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.