Pet Adoption Application

Your application will be reviewed in the next few days.  If you have any questions, please email:
spayillinois@insightbb.com

Pet Adoption Application
 ( * required fields )
Name of Pet You Are Applying For:  
Why Do You Think This is the Right Pet For You?:  
 Applicant/Co-Applicant Information
*Last Name:

*First Name:

*DOB:

Last Name:

First Name:

DOB:

*Address:

Apt. #:
*City:

*State:

*Zip:
*Home Phone:

Cell Phone:

    
*Email:    
*Do you own or rent your current residence?   Own           Rent  
*How long have you lived at this address?   *Any plans to move in the near future?
Landlord's/Condo board's name:  
Landlord's/Condo board's phone:    
*How did you hear about us?
 Family/Household Information
*Number of adults in the household: Relationships:
*Have all the adults in the household agreed to this adoption? Yes  No
*Number of children in the household: Ages of kids:
Have the children had pets before? Yes No  
*Do you expect your current family situation to change?  Yes No
*Is anyone in the household allergic to pets? Yes  No Who?
Do they take medication?  Yes No
Why would you like to adopt an animal from us?  (Check all that apply)
Companion for self Gift  
Companion for child Mouser / Farm pet  
Companion for another pet Other: 
Companion for another household member  
Number of cats at home: Inside Outside
Number of dogs at home: Inside Outside
Number of other pets at home: Inside Outside
 Employment Information
*Employer:            *Position held:
*Address:    
*City:             *State:       *Zip:
*How long have you been with this employer?   *Work Phone: 
 Pet Information
Have you had pets in the past or do you currently have pets? Please tell us about them.
Name Breed  Age Gender Spayed/
Neutered		 Where Is Pet Now? If deceased or living else-where, please explain.
M F Y N
M F Y N
M F Y N
*Have you ever given an animal away or relinquished an animal to a shelter? Yes No
If yes, what were the circumstances?     
 Veterinarian Information
Veterinarian's Name: Veterinarian's Phone:
When was your current pet's last visit to a veterinarian and why?  
 New Pet  Information
*How long have you been looking for a pet?   
*How much, on average, are you willing to spend on vet care and food every year for this pet?   
*What will you feed your new pet?   
*How often will you feed your new pet? 
*How much time are you prepared to allow for your new pet to adjust to your home?  
*Are you able to afford a bill of $200-$500 (or more) for emergency veterinary care?  Yes No
*How much do you expect to spend (in $) on maintenance for your pet in a year?    
*Are you committed to providing a responsible home for your pet’s entire life (15+ years)?  Yes No
*If you have to move where pets were not allowed, what would you do with your pet(s)?
*Who in the household will be the animal’s primary care giver?  
*When you are out of town, who will be the animal’s primary care giver? 
*In case of emergency, who will care for your pet? 
*Where will the animal be kept during the day?  
*During the night?  
*Will the pet be allowed outside?  Yes No            If yes, how often? 
*Do you have a fenced yard?  Yes No            If yes, how high? 
*Do you plan to declaw your cat?   Yes, Front Two Paws Only Yes, All Four Paws No Not sure
*How many hours per day will your pet be left alone?
*What would you do if your new pet develops a problem with:
*Inappropriate elimination or urination:  
*Keeping you awake at night: 
*Shedding excessive hair:
*Scratching on furniture/ counters/ kitchen table: 
*Chewing on plants:   
*Biting:  

IMPORTANT POINTS TO NOTE; PLEASE INITIAL THAT YOU HAVE READ EACH SECTION

The adoption fee must be paid by check or cash.  Cats MUST be picked-up in a pet carrier, no exceptions.

CATsNAP makes NO guarantees about the future health or temperament of the adopted animal and will not pay for ANY vet expenses after adoption. By typing your initials in the box below, you are agreeing to this term.

Remember, Catsnap automatically activates the gift of 30 days of ShelterCare Pet Insurance for you. It is pre-paid by Catsnap, and there is no further obligation after the expiration of your free gift.  Your gift applies to dogs and cats of all breeds and ages adopted from CATsNAP. Please visit sheltercare.com for more information. By typing your initials in the box below, you are agreeing to having been informed of ShelterCare terms.

COMPLETION AND SUBMISSION OF APPLICATION:

 By submitting the application, I certify that the information I have given is true. I understand that CATsNAP reserves the right to deny my application for any reason. I authorize the release of my pet(s) medical information from the veterinarian(s) listed above to CATsNAP.  I further authorize the investigation of all statements in this application.  CATsNAP may confiscate any animal because of falsification of this adoption application.  If for any reason I am unable to keep the adopted animal, I agree to release the animal(s) to CATsNAP. 

CATsNAP does not and cannot warrant the future health of this animal. Should any health issues or condition come to the attention of the adopter within 10 days of the adoption date, CATsNAP shall be notified by adopter.  CATsNAP will not be responsible for any veterinary charges incurred but reserves the right to assist in the treatment of the animal.  Adopters returning an adopted animal to CATsNAP within 14 days may request a partial refund (50%) of the adoption fee, not including the non-refundable microchipping charge.  If more than 14 days has passed since adoption, no refund will be given.

By typing your name below, you are signing this document by providing a digital signature.  Your online application will not be considered without it.

                  Date:
 


Revised: 06/25/07