Fill and Sign the Vsp Enrollment Forms

LOST DOG & CAT RESCUE FOUNDATION Name & Description of Cat ___________________________________ PO BOX 50037 Arlington VA 22205 703-295-DOGS Date:__________________________________________________ www.lostdogrescue.org CAT ADOPTION APPLICATION This form and a consultation with a LDCRF representative are designed to help you find the cat most compatible with your lifestyle. Completion of this application does not guarantee adoption of an LDCRF cat. Please respond to the questions below as completely as possible. In order to be considered as an adopter you must: 1. Be 21 years of age or older 2. Have a valid driver’s license or other government-issued ID 3. Have the knowledge and consent of your landlord if renting 4. Be willing and able to provide proper care, training and medical treatment Name: __________________________________________________________________________________________________ Street Address: ___________________________________________________________________________________________ City:________________________________ State: _________________________ Home Cell phone:______________________________ phone:_________________________ Zip:____________________________ Work phone:__________________________ Email address: ____________________________________________________________________________________________ Occupation:__________________________ Employer: ______________________________________________________ Employer Address: _________________________________________________________________________________________ Number of Adults in Household________ Number of Children_________ Ages of Children ___________________________ Are all the adults in your household aware that you are adopting a cat and in agreement? yes no Who will be the primary caregiver for your new cat?__________________ Is any member of the household allergic to cats?______ Do you own or rent your home? _________ Landlord’s name & phone # _____________________________________________ Why do you want a cat? ________________________________________________________________________________ What qualities are you looking for in your new cat? _________________________________________________________ Which of the following behaviors would be a serious problem for you? not getting along with other cats not good with children not getting along with dogs too active not playful Other:____________________________________ How many hours each day will the cat be without human companionship? ________________________________________________ Where will the cat be kept? Indoors outdoors indoor/outdoor barn other _____________________________________ Do you have a dog or cat door leading outside? _________ Will you have the cat de-clawed? Yes Is this your first cat? yes no maybe no If you presently have CATS, please complete: Cat’s Name Age Gender Spayed/ neutered? Current on vaccines? Tested for Feline Leukemia? Tested for FIV? Declawed? If you presently have DOGS, please complete: Dog’s Name Breed Age Gender Spayed/ neutered? Current on vaccines? If you have previously had companion animals, please complete: Name Breed Years owned What happened? Name of your veterinarian______________________________________________City/Town_______________________________ Have you ever turned a pet into a shelter? _________If yes, explain____________________________________________________ When you go on vacation/travel, who will care for the cat? __________________________________________________________ How much are you willing to spend on medical bills for your cat? ____________ What would you do if the bills go over this amount? _________________________________________________________________________________________________________ Are you ready to take responsibility for this cat for the next 15-20 years? __________________________________________ What provisions will you make for the cat should you become unable to care for it ?_______________________________________ Have you previously applied to adopt a dog or cat from LDCRF? ________If yes, when?__________ Explain:___________________ Have you ever relinquished or returned a dog or cat to LDCRF? ____ If yes, when? ___________ Explain:______________________ Are you willing to have a representative of LDCRF visit where the cat will be living?__________ I certify that the information above is true and understand that false information will result in nullification of this adoption. Prospective Adopter Signature:________________________________________________________________Date:____________ INTERVIEWERS, Please initial that you have discussed the following topics: flea/tick prevention vaccines return policy fees medical records/ future expenses litterbox issues exercise needs scratching needs Interviewer Approval:________________________________________________________________________Date:____________ Interviewer Approval:________________________________________________________________________Date:____________