Adoption

*Name of the cat you are considering adopting:

*Date:

*Full Name:

*Street Address:

*City, State, Zip:

*Home Phone (include area code):

*Cell Phone (include area code):

*Name, address and phone number of place of employment:

*Email address:

*Driver's license # or Valid ID PLEASE MAKE A COPY AND ATTACH

*How long have you lived at this current address?

*Do you plan to move or are you planning on moving in the next few months?
YesNo

If you ever move, have you considered that another place may not allow pets? What will you do if this happens?

*Does your development/association permit pets?
YesNo

*Is a deposit required?
YesNo

Deposit Amount:

*Do you own or rent?
OwnRent

If you rent, do you have permission to have pets?
YesNo

If you rent, please provide the name and phone number of your landlord so we may verify that you may have a pet.

Name:

Phone Number (include area code):

*What pets do you currently have? Please include their name, breed, gender, size and temperament.

If you currently have cat(s) have they been tested for feline aids and Leukemia? If yes, did they test positive or negative? If not tested, why?

If you currently have pets do you use flea/heartworm prevention? If yes, what brand?

If you have other pets, are they spayed or neutered? If no, please explain.

If you have other pets, are they up to date on their exam and vaccines?
YesNo

If yes, please provide proof of vaccines or previous vet so we may verify. If no, please schedule an appointment with us or any other vet and then provide proof.

*What is your financial situation? Are you prepared for veterinary care expenses? Care is just not food and litter. Cats need medical check- ups, vaccines, and dental cleanings. What if your cat gets sick? Or needs medicine? At what point would you surrender your cat, or feel that you cannot provide for the medical care financially? Please explain.

*If you adopt a cat and it develops undesirable behavior, e.g., not using the litter box, spraying around the house, what will you do?

*I certify that the information I have given above is true and correct. I also give permission to Pinellas Animal Hospital to contact the above listed landlord. Pinellas Animal Hospital has the right to deny any application without any question(s).
Acknowledge

*Applicant Signature:

*Date: