7120 S. Kings River Rd., Parlier, CA 93648
(559) 638-8696 (Option 1)
www.cathouseonthekings.com

Application Date: black line
Kitten/Cat Name: black line Description: black line

Adopter Information

Name:
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Age: black line
Address:  black line
City:
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State: black line
ZIP: black line
Country:
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Home phone: black line
Cell phone: black line
Work phone: black line
Email: black line
Employer's Name? black line  Position? black line
Time on the job? black line
How long at this address? black line
Is it a:
House
Apartment
Condo
Mobile Home
Other
Do you
Rent
Own
Live with someone who owns your home?
Are you allowed animals?
Yes
No
  Pet deposit amount $ black line
Landlord's name: black line Landlord's phone: black line
Homeowner: First name: black line Last name: black line Phone: black line
Number of adults in the home? black line
Number of children in the home? black line Ages of Boys? black line Ages of Girls: black line
Does anyone in the home have allergies?
Yes
No
Do you currently have pets?
Yes
No
 
  Other Species Age Fixed Breed (Dogs) Temperament
1.
Cat
Dog
Other
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Yes
No
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2.
Cat
Dog
Other
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Yes
No
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3.
Cat
Dog
Other
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Yes
No
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4.
Cat
Dog
Other
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Yes
No
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5.
Cat
Dog
Other
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Yes
No
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6.
Cat
Dog
Other
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Yes
No
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7.
Cat
Dog
Other
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Yes
No
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8.
Cat
Dog
Other
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Yes
No
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Where are your pets now? black line
What pets have you had previously as an adult? Please include their ages and how long you had them.
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What happened to them? If they died, what was their cause of death?
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If no pet experience as an adult, can you tell us about any pet experience that you have had?
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Does your home have a doggy door to the outside installed (used or not)?
Yes
No
Is the doggy door open for pet use at any time during the day?
Yes
No
Have you or anyone living with you adopted a pet from The Cat House on the Kings before?
Yes
No
Veterinary Clinic you (will) go to: black line Clinic Phone: black line
Will this pet be living in your home with you?
Yes
No
Describe the personality/temperament of the ideal cat: black line
As a kitten where will the cat(s) be?
Indoor only
Outdoor only
Indoor/Outdoor
As an adult where will the cat(s) be?
Indoor only
Outdoor only
Indoor/Outdoor
Where will you keep the litter box?
Laundry room
Garage
Bathroom
No box
Other
If "Other", where will the litter box be? black line
How many hours will the cat(s) be left alone during the day? black line
Have you ever surrendered an animal?
Yes
No
Please explain:
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Have you ever had a pet hit by a car?
Yes
No
Have you ever lost a pet or had one die of accident or injury other than being hit by a car?
Yes
No
Do you know how to treat the following?
 
Hairballs:
Yes
No
Fleas:
Yes
No
Ear Mites:
Yes
No
 
Tape Worms:
Yes
No
Round Worms:
Yes
No
Would you have the cat(s) declawed?
Yes
No
Why? black line
How much do you think it will cost per month on average to care for the cat(s)? $ black line
Who will be primary caretaker for the cat(s)? black line
Who will take care of the cat(s) if you go away for a few days? black line
Non-household FAMILY reference name. (We only accept FAMILY as as reference. Do not list a friend):
First name: black line
Last name: black line
Phone: black line
Please note: We require an actual reference. If you have no family, please use a professional person who knows you.
Reference's address: black line City: black line
State: black line
ZIP: black line
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Would you consent to a home visit?
Yes
No
Why? black line
How did you hear about us? black line
If you move, what will you do with the cat(s)? black line
Full name of person who will care for the cat(s) if you are unable to? black line
Are you financially able and willing to give the cat(s) the medical care he/she may need?
Yes
No
Are you prepared to care for the cat(s) for his/her natural life (which may be over 20 years)?
Yes
No
May we call you at work if unable to reach you at home for our follow-up calls?
Yes
No
Is there anything else you'd like to tell us?
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Signature

Signature: black line
Date: black line

For staff use only:

Total:
$black line
CheckTotal amount received:$black lineCheck Number:black lineDriver's License#black line
CashTotal amount received:$black line
AKC
Confirmation # black line