The Cat House on the Kings
7120 S. Kings River Rd., Parlier, CA 93648
(559) 638-8696 (Option 1)
www.cathouseonthekings.com
Application Date:
Kitten/Cat Name:
Description:
Adopter Information
Name:
Age:
Address:
City:
State:
ZIP:
Country:
Home phone:
Cell phone:
Work phone:
Email:
Employer's Name?
Position?
Time on the job?
How long at this address?
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 $
Landlord's name:
Landlord's phone:
Homeowner:
First name:
Last name:
Phone:
Number of adults in the home?
Do your housemates agree to a new pet?
Yes
No
Please provide the FIRST and LAST NAMES of ALL adults in the home and your RELATIONSHIP to them:
Number of children in the home?
Ages of Boys?
Ages of Girls:
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
Yes
No
2.
Cat
Dog
Other
Yes
No
3.
Cat
Dog
Other
Yes
No
4.
Cat
Dog
Other
Yes
No
5.
Cat
Dog
Other
Yes
No
6.
Cat
Dog
Other
Yes
No
7.
Cat
Dog
Other
Yes
No
8.
Cat
Dog
Other
Yes
No
Where are your pets now?
What pets have you had previously as an adult? Please include their ages and how long you had them.
What happened to them? If they died, what was their cause of death?
If no pet experience as an adult, can you tell us about any pet experience that you have had?
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:
Clinic Phone:
Will this pet be living in your home with you?
Yes
No
Describe the personality/temperament of the ideal cat:
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?
How many hours will the cat(s) be left alone during the day?
Have you ever surrendered an animal?
Yes
No
Please explain:
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?
How much do you think it will cost per month on average to care for the cat(s)? $
Who will be primary caretaker for the cat(s)?
Who will take care of the cat(s) if you go away for a few days?
Non-household
FAMILY
reference name. (We only accept FAMILY as as reference. Do not list a friend):
First name:
Last name:
Phone:
Please note:
We require an actual reference. If you have no family, please use a professional person who knows you.
Reference's address:
City:
State:
ZIP:
Reference's relationship to you:
Would you consent to a home visit?
Yes
No
Why?
How did you hear about us?
If you move, what will you do with the cat(s)?
Full name of person who will care for the cat(s) if you are unable to?
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?
Signature
Signature:
Date:
For staff use only:
Total:
$
Check
Total amount received:
$
Check Number:
Driver's License
#
Cash
Total amount received:
$
AKC
Confirmation #