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Chesapeake Cats and Dogs
Adoption Application
P.O. Box 345  Grasonville, MD 21638-0345
 410-827-3148     FAX 410-827-6808

Name: __________________________________________________________________

Home Phone:  __________________Work/Cell Phone: ___________________________

Home Address: ___________________________________________________________

City/State/Zip Code: ______________________________________________________

Email address:  ___________________________________ 

May we add you to Chesapeake Cats’ email list?  YES/NO

Cat Requested: __________________________ Age of pet______________________

Description of pet: _______________________________________________________

Any special need: ________________________________________________________

1.      Why do you want to adopt this animal?

________________________________________________________________________

________________________________________________________________________

2.      List the types of pets owned in the past 5 years:

TYPE              SEX/AGE       ALTERED      VACCINATED         WHAT IS STATUS

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

3.      How many children are in your household?______ Ages:_________________

4.      Is anyone in your household allergic to animals? YES/NO ___

5.      How many hours will this pet be alone per day?________________________

6.      Who will be responsible for the actual care of this animal?________________

7.      If you take a vacation, who will take care of this pet?____________________

8.      Will this cat be kept:
         Indoors only _____  Outdoors only ______   Indoors/outdoors ______

9.      Do you live in a: Single family home____ Townhouse ____ Apartment _____ 

10.  Do you own or rent? _____________________

11.  If you rent, we will be contacting the landlord to inquire if pets are permitted. 

Please provide his/her name and telephone number:  _____________________________________________________________

12.  If you move, will you take this pet with you? YES/NO ___

13.  Have you ever given up an animal?  YES/NO  ___

     Why?__________________________________________________________

14.  Who is your current vet?

Name:_____________________________________

 
City/State:  ___________________________________________

Telephone Number ___________________________

                  (We will be contacting the vet for a reference.)

 
15.  Are you willing and able to take on the responsibility for this cat for the next10-15 years?  YES/NO ______

16.  We will be doing a home visit prior to approving your adoption application. 
        What time of day is best for you and your family--morning, ___afternoon ___or evening?
        Weekday or weekend?  ___________________________________

Signature of Adopter:___________________________________ Date  ______________

Signature of Chesapeake Cats Volunteer _______________________________________