Cat Adoption Application Your Name*Address*Town*Postal Code*Phone Number*Alternate Phone NumberEmail Who are you adopting this animal for?*SelfRelativeFriendChildOtherHave all members of your household been introduced to the animal?YesNoNumber of Adults at home? (18+ yrs)*Please enter a value between 1 and 10.Number of Young Children at home? (0-7 yrs)*Please enter a value between 0 and 20.Number of Children at home? (8-17 yrs)*Please enter a value between 0 and 20.Any severe allergies in your family?*YesNoHow busy is your family?*VeryA littleSometimesNot at allHow would you describe yourself?*LoudCalmQuietHow would you describe the others in your house?*LoudCalmQuietAre you planning on the following in the next month? Moving, Holiday, Major Change in ScheduleDo you have a family vet?YesNoNot yetVeterinarian Contact Information:Type of home?*HouseApartmentAcreageRent or own?RentRent ShareOwnOwn ShareOutside areas?Who will be the cat’s primary caretaker?Where will your cat stay during the day?OutsideInsideBothOtherWhere will your cat stay during the night?OutsideInsideBothOtherWhere will your cat stay during vacations?At home with no careAt home with careBoardedWith a friendHave you had cats before?YesNoWhat happened to them?Have you ever surrendered an animal to a shelter?YesNoWhy?Do you have the landlord’s permission to have pets?YesNoPlease give landlord’s name & phone numberDo you have other cats?YesNoThird ChoicePlease Specify for Cat #1Spayed FemaleIntact FemaleNeutered MaleIntact MaleTemperament with other catsFriendlyDisinterestedAfraidNot SurePlease Specify for Cat #2Spayed FemaleIntact FemaleNeutered MaleIntact MaleTemperament with other catsFriendlyDisinterestedAfraidNot SurePlease Specify for Cat #3Spayed FemaleIntact FemaleNeutered MaleIntact MaleTemperament with other catsFriendlyDisinterestedAfraidNot SureDo you have other animals?YesNoPlease specify type and breed for #1Temperament with other catsFriendlyDisinterestedAfraidNot SurePlease specify type and breed for #2Temperament with other catsFriendlyDisinterestedAfraidNot SureReferences are required - Please list two references who can comment on your character and experience with animals. REFERENCES MUST NOT BE FAMILY MEMBERSReference 1*Please include Name, Phone number and Relationship to this personReference 2Please include Name, Phone number and Relationship to this personDesired AnimalDesired SexMaleFemaleEitherCoatShortMediumLongEitherAgeKittenAdultSeniorAnyBreed, Type, or ColorBe Friendly with people/petsVery ImportantImportantNot ImportantBe interactive with youVery ImportantImportantNot ImportantActivity LevelVery ActiveActiveModerateCalmVery CalmEitherNever scratch the furnitureVery ImportantImportantNot ImportantAlways use the litterboxVery ImportantImportantNot ImportantNever show aggressive behaviourVery ImportantImportantNot ImportantProblems you are willing to work onI'm interested in working on problemsYesNoDependsBehavioural ProblemsLitterboxScratching FurnitureBothWill you have this cat de-clawedYesNoSocialization ProblemsFearfulShynessNervousnessAll of the aboveUnder what conditions would you return your cat to ICAN?Aggressive, Too timid, Wrong decision, Scratching furniture, Litter box problem, Does not get along with other pets, Too costly, Not enough time, Cat's health problems, New babyHow long will you give your new cat to adapt to his/her new surroundings?Less than a weekOne to two weeksOne MonthAs long as it takesAgreementsHave you ever been convicted of neglect or cruelty to animals?YesNoAre you willing to have an ICAN representative do a home visit by appointment?YesNoIf no, why?Tick the checkboxes below to indicate to us you completely understand and agree to the following statements. It is my responsibility to see and evaluate this kitten/cat for myself before agreeing to adoption This kitten/cat will reside in my home as a companion. I will provide him/her with adequate food, water, shelter, affection, socialization and medical care I will not sell, trade, give away or otherwise dispose of this kitten/cat. If at any time I am unable OR unwilling to care for this kitten/cat, I agree to contact ICAN to return him/her to ICAN or to discuss finding him/her a new home ICAN is in no way liable or responsible for any damage, accident or injury resulting from the placement of a kitten/cat into my household ICAN cannot be held responsible for any health or temperament problems of this kitten/cat I will inform ICAN of any changes to my contact information Your comments:CaptchaICAN Falsified information will lead to automatic rejection of the application. ICAN reserves the right to refuse any applicant. I declare that all information provided in this application is true and complete.
