Adoption form

Please tell us about yourself.

Name *

Address:

City:

State: Please Select Alabama Alaska Alberta American Somoa Arizona Arkansas Bermuda British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Military - AA Military - AE Military - AP Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon

Zip:

E-mail: *

Home Phone: *

Work Phone:

Cell:

Please tell us which cat(s) and why.

Which cat are you interested in adopting:

Why do you want to adopt a cat? (Please note that kittens are only adopted in pairs, unless there is another kitty or cat friendly animal in the household.)

How did you hear about this cat: Please Select Billerica Cat Care Coalition Website Billerica Cat Care Coalition Member Petfinders.org Friend Other

What living situation would the cat(s) be exposed to?

Do you own or rent: Please Select Own Rent

Do you have children: Please Select Yes No

If yes, how many, and what are their ages?:

Who else lives with you:

Do you smoke: Please Select Yes No

Pet saftey

Do you have other pets: Please Select Yes No

If yes, what kind and how many:

If you have owned a cat before: Please Select Yes No

If yes, for how long:

What are your pet's names:

Do you have a veterinarian: Please Select Yes No

Please provide your veterinarian's name and telephone number:

Have you ever lost a cat or had a cat die: Please Select Yes No

If yes, what happened:

How long do you plan on keeping the cat:

How to plan to care for grooming such as nail care, dental care and general grooming:

How will you handle the kitten or cat's need to scratch.  What if they scratch your furniture?  Please give a detailed description:

Will this cat be an indoor or outdoor cat: Please Select Indoor Outdoor

Please provide two (2) references. Please include name, telephone number and relationship

Reference #1:

Reference #2:

Will you allow a follow-up visit, in home, in one (1) month: Please Select Yes No

If for any reason, you no longer want the cat(s) or can no longer care for the cat(s), do you promise to contact the Billerica Cat Care Coalition immediately and bring the cat(s) back to us: Please Select Yes No

To help defray the cost of their care, we require a $90 non-refundable adoption fee for cats and a $150 non-refundable adoption fee for kittens from 7 weeks to 12 months. In addition, responsible pet ownership means incurring some expenses, including medical care. We estimate the annual cost of average veterinary care (yearly exam, shots, and treatment for at least one condition) to be at least $100.  
Are you aware of these costs and are you prepared to cover them?: Please Select Yes No

I/We, the undersigned, promise to provide sufficient shelter, food, water, medical care, comfort and love so that this animal will thrive and lead a happy indoor life as best as we are able. I/We will make available veterinary care as needed. I/We promise never to declaw him/her. If I/we must move from our current location, I/we will either take him/her with us or provide for his/her care by returning him/her to the Billerica Cat Care Coalition.

My typed signature below signifies that I agree to the terms of this adoption and that all the information provided is true and accurate.

I understand that there is a $90 non-refundable adoption fee for cats.  I also understand there is a $150 non-refundable adoption fee for kittens from 7 weeks to 12 months and "special needs" kitties require a $50.00 adoption fee.

Please type your full name:

Date: