London Animal Care Centre



964258186493Cat Adoption Questionnaire00Cat Adoption Questionnaire3949065-44450Animal Name: ______________________________P#: _____________ Adoption Date: __________A#: _____________ ACT Initials: _____________ Approved On Hold00Animal Name: ______________________________P#: _____________ Adoption Date: __________A#: _____________ ACT Initials: _____________ Approved On Hold-2956-4044300546102140585Why are you adopting a cat? Companion for myself / children / petRodent / pest controlCulture / religion Gift for another personReplace a lost pet/ deceased petOther (please specify):__________________________________________What best describes your living environment?ApartmentCondoHouseIn your household there are: #Infant ______Young children (under 12) ______Mature children (12 – 17) ______Adults (18 – 64) ______Senior (64+) ______Cats ______Dogs ______Small animals ______Other (please specify): __________________________________________ If you have roommates, have you addressed issues such as pet-related allergies and verified that they support your decision to adopt a pet?YesNoI live aloneI am prepared to adopt a cat with:No health issuesA minor medical condition (e.g. FIV)A veterinary prescribed dietA condition requiring medication00Why are you adopting a cat? Companion for myself / children / petRodent / pest controlCulture / religion Gift for another personReplace a lost pet/ deceased petOther (please specify):__________________________________________What best describes your living environment?ApartmentCondoHouseIn your household there are: #Infant ______Young children (under 12) ______Mature children (12 – 17) ______Adults (18 – 64) ______Senior (64+) ______Cats ______Dogs ______Small animals ______Other (please specify): __________________________________________ If you have roommates, have you addressed issues such as pet-related allergies and verified that they support your decision to adopt a pet?YesNoI live aloneI am prepared to adopt a cat with:No health issuesA minor medical condition (e.g. FIV)A veterinary prescribed dietA condition requiring medication13909671394Adopter Name: ______________________________________________ Citizen / Perm. Resident / Student or Work Visa Address: _______________________________________________ Apt: _______ City: ___________________________Postal Code: __________ Phone: _____________________ Email: ___________________________________________00Adopter Name: ______________________________________________ Citizen / Perm. Resident / Student or Work Visa Address: _______________________________________________ Apt: _______ City: ___________________________Postal Code: __________ Phone: _____________________ Email: ___________________________________________36576002140585How often do you plan to have your cat seen by a vet?When sickTwice per yearAnnuallyOnce every 3 yearsWhere will the cat be housed?IndoorsIndoors and outdoorsOutdoors Do you plan on declawing your cat?YesNoIf someone gets scratchedIf the cat scratches my furnitureOther (please specify):_________________________________________What methods do you plan on using to train your cat?Spray bottlePositive reinforcementPhysical reinforcement (e.g. tap on the nose)Clicker training“No” and pointOther (please specify):_________________________________________What enrichment do you plan on providing for your cat?ToysInteractive playBrushing / pettingScratching postCatnip / treatsWalksTricks / trainingPuzzles / brain games00How often do you plan to have your cat seen by a vet?When sickTwice per yearAnnuallyOnce every 3 yearsWhere will the cat be housed?IndoorsIndoors and outdoorsOutdoors Do you plan on declawing your cat?YesNoIf someone gets scratchedIf the cat scratches my furnitureOther (please specify):_________________________________________What methods do you plan on using to train your cat?Spray bottlePositive reinforcementPhysical reinforcement (e.g. tap on the nose)Clicker training“No” and pointOther (please specify):_________________________________________What enrichment do you plan on providing for your cat?ToysInteractive playBrushing / pettingScratching postCatnip / treatsWalksTricks / trainingPuzzles / brain games5642610285115006351485090Please answer the following questions to help us find the purrrfect match for you!00Please answer the following questions to help us find the purrrfect match for you!4294658292012000-12480099578944384Cat Adoption Questionnaire: Continued00Cat Adoption Questionnaire: Continued47625878205Have you owned a cat before?Yes, I was the sole caretakerYes, I was not the sole caretakerNo, I have not owned a cat beforeBehaviours I am NOT willing to work with are:VocalizationShy / fearful / hidingUrinary / litterbox issuesBiting / rough playScratching furnitureAttempts to escapeDoes not get along with children / other animalsOther (please specify):__________________________________________________________________________________00Have you owned a cat before?Yes, I was the sole caretakerYes, I was not the sole caretakerNo, I have not owned a cat beforeBehaviours I am NOT willing to work with are:VocalizationShy / fearful / hidingUrinary / litterbox issuesBiting / rough playScratching furnitureAttempts to escapeDoes not get along with children / other animalsOther (please specify):__________________________________________________________________________________3846195880110It is important my new cat is:QuietPlayfulAffectionateCalmEnjoys being heldVocal / chattyEnergeticDominantSubmissiveGets along with:Children CatsDogsSmall animals00It is important my new cat is:QuietPlayfulAffectionateCalmEnjoys being heldVocal / chattyEnergeticDominantSubmissiveGets along with:Children CatsDogsSmall animals-366555276215I, the undersigned, am of at least 18 years of age, and verify that all of the above information is true and correct. I understand that this cat was a stray and therefore has no known medical or behavioural history. All cats have been vaccinated, treated for fleas and worms, spayed / neutered, and microchipped. While appearing healthy, this cat could have an underlying health problem which may not have been detected.I understand that any further veterinary care for the adopted cat is at my discretion, however the London Animal Care Centre highly recommends having the animal examined by a veterinarian as soon as possible, ideally within 72 hours of adoption. I understand that the London Animal Care Centre will not reimburse me for any medical expenses incurred after the animal has been adopted.I understand that I may return this animal to the shelter for a full refund within 2 weeks if the pet should prove to be unsuitable to the new home. I understand that some animals take many weeks to settle into a home and agree to contact the shelter for guidance prior to returning this animal.I give LACC permission to take my photograph for use on social media to promote adoptionsI agree to receive electronic messages from Royal Canin Canada Company. With this agreement I will receive a complimentary Royal Canin Adoption kit and help to feed the dogs and cats in the shelter. ______________________________________ ______________________________Applicant signature Date00I, the undersigned, am of at least 18 years of age, and verify that all of the above information is true and correct. I understand that this cat was a stray and therefore has no known medical or behavioural history. All cats have been vaccinated, treated for fleas and worms, spayed / neutered, and microchipped. While appearing healthy, this cat could have an underlying health problem which may not have been detected.I understand that any further veterinary care for the adopted cat is at my discretion, however the London Animal Care Centre highly recommends having the animal examined by a veterinarian as soon as possible, ideally within 72 hours of adoption. I understand that the London Animal Care Centre will not reimburse me for any medical expenses incurred after the animal has been adopted.I understand that I may return this animal to the shelter for a full refund within 2 weeks if the pet should prove to be unsuitable to the new home. I understand that some animals take many weeks to settle into a home and agree to contact the shelter for guidance prior to returning this animal.I give LACC permission to take my photograph for use on social media to promote adoptionsI agree to receive electronic messages from Royal Canin Canada Company. With this agreement I will receive a complimentary Royal Canin Adoption kit and help to feed the dogs and cats in the shelter. ______________________________________ ______________________________Applicant signature Date-336554960620Please read and sign the following00Please read and sign the following-304803328736Please select any additional topics you’d like to discuss today00Please select any additional topics you’d like to discuss today53750344115588Play behaviourLitter box issuesPlay aggressionSigns of a sick catOther:___________________00Play behaviourLitter box issuesPlay aggressionSigns of a sick catOther:___________________29000454116223MicrochippingDeclawingEnrichmentScratching behaviourAdoption preparationIndoor cat facts00MicrochippingDeclawingEnrichmentScratching behaviourAdoption preparationIndoor cat facts3257554116224Introducing your cat to:BabyChildrenDogCatHome00Introducing your cat to:BabyChildrenDogCatHome ................
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