Adirondack Region Feline Adoption Pre-Approval Application

Applicant Information

First Name *

Last Name *

Address *

Address

Street Address

Apt. # or Suite

City

State/Province

Zip/Postal

Email Address *

Mobile Phone *

Home Phone *

Date of Birth *

Age

Who will this pet be for? *

Myself

A gift

A gift for whom? *

Please state relationship and age of recipient.

Applicant Employment Information

Occupation/Job Title *

Is this a full-time or part-time job? *

Full-time

Part-tiime

Normal Work Hours *

Please list days and times.

Company Name *

Company Address *

Business Phone

How long at current job? *

Do you travel for work? *

Yes

No

How often?

Previous Occupation/Job Title

Previous Company Name

Previous Company Address

How long at previous job?

Other Household Resident Information

How many children? *

Age(s) *

Please list the ages of all children living in the home under the age of 21.

Other *

Please explain.

Spouse/Partner/Fiance Information

Name of Spouse/Partner/Fiance *

Age *

Mobile Phone *

Occupation/Job Title *

Is this a full-time or part-time job? *

Full-time

Part-tiime

Normal Work Hours *

Please list days and times.

Company Name *

Company Address *

Business Phone *

How long at current job? *

Do they travel for work? *

Yes

No

How often? *

Previous Occupation/Job Title

Previous Company Name

Previous Company Address

How long at previous job?

Roommate #1 Information

Name of Roommate #1 *

Age *

Mobile Phone *

Occupation/Job Title *

Normal Work Hours *

Please list days and times.

Company Name *

Company Address *

Business Phone *

How long at current job? *

Do they travel for work? *

Yes

No

How often? *

Previous Occupation/Job Title

Previous Company Name

Previous Company Address

How long at previous job?

Do you have another roomate? *

Yes

No

Roommate #2 Information

Name of Roommate #2 *

Age *

Mobile Phone *

Occupation/Job Title *

Normal Work Hours *

Please list days and times.

Company Name *

Company Address *

Business Phone *

How long at current job? *

Do they travel for work? *

Yes

No

How often? *

Previous Occupation/Job Title

Previous Company Name

Previous Company Address

How long at previous job?

Do you have another roomate? *

Yes

No

Roommate #3 Information

Name of Roommate #3 *

Age *

Mobile Phone *

Occupation/Job Title *

Normal Work Hours *

Please list days and times.

Company Name *

Company Address *

Business Phone *

How long at current job? *

Do they travel for work? *

Yes

No

How often? *

Previous Occupation/Job Title

Previous Company Name

Previous Company Address

How long at previous job?

Do you have another roomate? *

Yes

No

Housing Information

Do you own or rent? *

Rent

Own

What floor?

How long at present address? *

If less than 5 years, please list previous address.

Street Address

Apt # or Suite

City

State/Province

Zip/Postal

Are you planning on moving within the next 12 months? *

Yes

No

When/Where

If renting, does your lease allow pets?

Yes

No

List any restrictions with your rental agreement.

Landlord/Management Company Name *

Landlord/Management Contact Number *

Do you have use of a private yard *

Yes

No

Is it fenced?

Yes

No

Fence Height

Do you have a doggy door? *

Yes

No

If yes, do you lock it and when? *

Reference 1

First Name *

Last Name *

Address *

Address

Street Address

Apt. # or Suite

City

State/Province

Zip/Postal

Relationship *

Mobile Phone *

Home Phone *

Reference 2

First Name *

Last Name *

Address *

Address

Street Address

Apt. # or Suite

City

State/Province

Zip/Postal

Relationship *

Mobile Phone *

Home Phone *

Reference 3

First Name *

Last Name *

Address *

Address

Street Address

Apt. # or Suite

City

State/Province

Zip/Postal

Relationship *

Mobile Phone *

Home Phone *

Allergies

Do you or anyone in your household have pet allergies? *

Yes

No

If yes, which type of animals?

Cats

Dogs

OtherOther

If yes, who is allergic?

Please list all residents with allergies and their relationship to adopter. (i.e.; John Smith/spouse, Kevin Smith/son, etc.)

Are you, or anyone in your household, currently on medication for the pet allergies?

Yes

No

If yes, what type of medication?

Pet Interests

What type of pet are you interested in adopting? *

Kitten

Cat

Why do you want to adopt? *

Companion

Companion for other pet

For the kids to play with

OtherOther

Have any pets caught your eye on our website, Instagram or Facebook posts? *

Not yet

Yes

If yes, please give us the pet's name and adoption number (if available).

What qualities are important for your cat/kitten to have?

Lap cat

Affectionate

Playful

Independent

Do you have any preference to gender or fur color?

Female

Male

ColorsColors

When are you ready to adopt? *

Ready to go right now

Within the next 30 days

OtherOther

Is there anything else you would like to add?

Pet History

Do you currently have other pets now? *

Yes

No

Cat(s) or Dog(s)

Cat(s)

Dog(s)

How many cats?

Please list the names and ages of all cats living in the home.

Does your cat(s) go outside?

Yes

No

How many dogs?

Please list the names, breeds, and ages of all dogs living in the home.

Has your dog(s) ever been around cats? *

Yes

No

Where do you keep your dog during the day?

Where do you keep your dog at night?

Have you ever owned a cat with behavior issues? *

Yes

No

If yes, what were the issues and how did you handle it? *

Have you ever had a pet before, even growing up with a family pet?

Yes

No

Please list all pets, ages, and what happened to them.

Have you ever previously adopted from: *

North Shore Animal League America

Other rescue group or shelter

Breeder

I've never previously adopted a pet.

Please list the rescue group or shelter.

Have you ever surrendered an animal to a shelter or given your pet to someone else? *

No

Yes

Please describe the circumstances.

Have tried to adopt an animal from another rescue group? *

No

Yes

What happened?

Would any of the following prompt you to give up your cat? *

Please list... *

Are you planning to declaw this cat(s) or kitten(s)? *

No

Yes

If yes, why? *

Social Media

Do you want to share your social media pages? *

No

Yes

Facebook

Insert link to page. For example, www.facebook.com/theanimalleague

Instagram

Insert link to page. For example, www.instagram.com/animalleague/

Veterinarian Information

Do you currently have a Veterinarian? *

Yes

No

Please call your veterinarian as soon as possible upon completion of this application to give permission for North Shore Animal League America to speak to them about your records.

Name of Veterinary Practice

Name of Veterinarian

Vet Address

Street Address

Unit or Suite

City

State/Province

Zip/Postal

Vet Contact Number

How long have you used this Veterinarian?

Have you ever used a Veterinarian in the past? *

Yes

No

Name of Former Veterinary Practice

Name of Former Veterinarian

Former Vet Address

Street Address

Unit of Suite

City

State/Province

Zip/Postal

Former Vet Contact Number

For how long did you used this Vet?

How long ago?

General Info

Are you prepared to cover any veterinary expenses your pet may incur throughout it's life? *

No

Yes

Is there a limit?

No

Yes

How much is too much?

Would you consider euthanizing your pet because of medical costs? *

No

Yes

Explain

Do you understand that if you are no longer able to keep your animal you must notify North Shore Animal League America? *

No

Yes

Do you currently have, or in the past had, a declawed kitten/cat? *

No

Yes

Do you plan to declaw your kitten/cat? *

No

Yes

What would you do if your kitten/cat would not stop clawing your furniture? *

Do you have separate room/small area in your home to allow your new pet to acclimate to their new surroundings? *

No

Yes

Where will your pet be kept? *

Indoors

Outdoors

Both

Do you realize you need to take your pet for annual exams? *

No

Yes

Who will take care of your pet when you go out of town? *

Are you aware that owning a pet is a 15-20 year commitment? *

No

Yes

What would your course of action be if you could no longer keep your pet? *

How did you hear about us?

Please select one:

The Chronicle

The Post Star

Local Paper

Magazine

What station?

What event?