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Lambertville Animal Welfare

Adoption Application

Date: ____________________ Your Name: _______________________________

Name of cat(s)/ kitten(s) you are applying to adopt: _____________________________

Address: _______________________________________________________________

City: ____________________________ State: ________ Zip code: _____________

Phone #1: ______________________ Phone #2: ______________________________

Email: _________________________ Employer: ______________________________

Your age: ___________ Do you own or rent? _____

Type of residence: House Apartment Condo Townhouse Farm Other:

Contact information for landlord or condo/ townhouse association: _____________________________________________________________________________

|Household Members |

|Name |Age |Relationship to applicant |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

Does anyone in your household have an allergy to cats? ______ If so, please list:

________________________________________________________________

|Household Pets |

|Name |Age |Species |Spayed/ |Where does pet live? |

| | | |neutered? | |

| | |Dog Cat Other | Yes No |Indoor Outdoors Both |

| | |Dog Cat Other | Yes No |Indoor Outdoors Both |

| | |Dog Cat Other | Yes No |Indoor Outdoors Both |

| | |Dog Cat Other | Yes No |Indoor Outdoors Both |

| | |Dog Cat Other | Yes No |Indoor Outdoors Both |

| | |Dog Cat Other | Yes No |Indoor Outdoors Both |

If a pet passed away recently, please indicate the circumstances: __________________

______________________________________________________________________

Have you had other pets in the last 5 years who are not listed above? ___________

If so, where are they now? ________________________________________________________

Have you ever been in a situation where you had to give up a pet? ________

If so, please explain: _____________________________________________________________

Do you or anyone in your household have any health conditions that could make it dangerous for you to be bitten or scratched by an animal? _________________

Under what circumstances would you considering giving up a pet in the future? (ex. allergies, scratching furniture, not using the litterbox, etc): ______________________________________

______________________________________________________________________________

If you have children or plan to extend your family, are you comfortable with the possibility of a child being bitten or scratched by an animal? Yes No Unsure N/A

Some cats require several weeks or even months to acclimate to their new home, family, and other pets. Are you willing to allow for this adjustment period? Yes No Unsure

Experience with cats: First time Had 1 or 2 Had many

Where will your adopted cat live? Indoors only Indoor/ outdoor Outdoors only Barn/ Garage

What type of food do you plan to feed your new cat? ___________________________________

Which veterinarian do you plan to use for your new cat? ________________________________

Under what circumstances would you have your adopted cat declawed? ____________________

______________________________________________________________________________

If you were to move, what would you do with your cat? _________________________________

References:

Have you had a vet in the past 4 years? Yes No (If yes, please complete questions 1 and 2 below. If no, please complete questions 2 and 3 below)

1. Veterinary reference

Practice name: _____________________________ Phone: _____________________

If your pet's veterinary records are listed under a name other than yours, please list that name:

_________________________________________

2. Personal reference A (must be an acquaintance of at least 6 months, and can not be a relative):

Name: ___________________________________ Phone: ______________________

Relationship: _______________________________________

3. Personal reference B (must be an acquaintance of at least 6 months, and can not be a relative):

Name: ___________________________________ Phone: ______________________

Relationship: _______________________________________

Terms, Signature, and Release: (Please initial and sign below)

I understand that Lambertville Animal Welfare reserves the right to deny an adoption request for any, or no, reason, and that Lambertville Animal Welfare may choose not to reveal specific reasons. X ________

I affirm that all of the information on this application is true and complete and that any incorrect information or omissions are grounds for denial. X ________

I hereby grant permission for any veterinary offices listed above to speak to a Lambertville Animal Welfare volunteer to discuss information related to my ownership and care of pets.

X ________

I have read and understand the Lambertville Animal Welfare policy regarding the Age of Potential Adopters (see below). X ________

Our Policy Regarding the Age of Potential Adopters:

Adopting a cat is a lifetime commitment, so that the cat receives attention, care and respect for the rest of his life. We need to feel comfortable that each potential adopter:

• can provide a stable environment for the cat

• has the ability to pay for medical care, as well as basic necessities

• will be in good enough health to care for the cat.

For these reasons, we apply additional scrutiny to potential adopters who are less than 21 years of age or older than 70 years of age. We treat each case individually and are happy to work with you to find a solution.

Potential Adopters Less than the Age of 21:

A potential adopter who is at least 18 years of age but less than 21 years of age, is less likely than an older person:

• to have the financial means to care for a cat

• to have a stable living situation to ensure that the cat will have an appropriate home for an extended period of time.

For these reasons, our volunteer screening applications may ask questions that seem intrusive.

Potential Adopters Older than the Age of 70:

A potential adopter who is over 70 years of age is less likely than a younger person:

• to outlive a young cat

• to remain healthy enough to provide a lifetime of care for a cat.

For these reasons, our volunteer screening applications may ask questions that seem intrusive.

In adopting this cat you agree to:

a. Permit Lambertville Animal Welfare volunteers to conduct a home visit before placing the cat and to conduct follow up calls for the purpose of assuring the proper care and adjustment of the cat.

b. NEVER put the cat in a pound or shelter. In the event you cannot keep the animal, you MUST IMMEDIATELY contact Lambertville Animal Welfare at 609-397-0461 or Info@.

c. Register your adopted cat's microchip immediately after adoption. Notify us IMMEDIATELY if the animal becomes missing or lost so we may assist in finding it.

d. Have a safe and fully functional cat carrier for every cat in your household, including your newly adopted cat, at the time of adoption.

e. Accept possession, title and responsibility of the animal described above at your own risk, and hereby release and waive any right against Lambertville Animal Welfare which you may have now, or in the future, for any damages to person or property caused by said animal. Recognize that animals, like humans, differ in their responses to different situations and that we cannot make any claims or representations as to previous or future behavior and actions of the animal.

IN SIGNING BELOW YOU AGREE TO ALL OF THE TERMS ABOVE AND UNDERSTAND THAT IF YOU HAVE GIVEN FALSE OR MISLEADING INFORMATION OR DO NOT FOLLOW THE TERMS OF THIS CONTRACT, ANY OF THE ABOVE AS INDIVIDUALS OR AS AN ORGANIZATION MAY RECLAIM THIS ANIMAL AND START LEGAL PROCEEDINGS AGAINST YOU, AT YOUR EXPENSE, AND MAY ASSESS DAMAGES IN THE AMOUNT OF $1000.00 AGAINST YOU. YOUR FAILURE TO COMPLY WITH ANY OF THE ABOVE TERMS OF THIS AGREEMENT WILL RESULT IN THE ANIMAL RETURNING TO ANY OF THE ABOVE-MENTIONED OR THEIR REPRESENTATIVES.

Lambertville Animal Welfare reserves the right to reclaim the adopted animal if the animal is not being treated humanely or is abused. This would include but is not limited to inadequate food, water, shelter, socialization, and exercise.

I HAVE READ, UNDERSTAND, AND WILL COMPLY WITH ABOVE STATED CONDITIONS.

If you are applying via email, please write your name and the date below, and we will ask you to sign this application at the time of adoption.

Signed: _________________________________________ Date: _________________

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