CHELSEA
BAILEY BUTTE-SILVER BOW ANIMAL SHELTER
PEOPLE
AND CATS PROFILE
Thank you for
filling out this profile. The
information you provide
will help us help
you find the best match for you and your family.
Date
_____________________ Employee
__________________
ABOUT YOU AND
YOUR FAMILY
Name
__________________________________ Driver’s License/I.D#
______________________________
Name
__________________________________ Driver’s License/I.D#
______________________________
Street
address _____________________________ City ________________ State __________
Zip ________
Home phone
_________________ Place of work ______________________ Work phone
_______________
Type of
housing (check all that apply): Own Rent Live with parents Military
Length
of time at current address: Months ___________ Years ____________
Landlord
name _____________________________________________ Phone
_________________________
Name of
friend not living with you _____________________________ Phone
_________________________
Veterinarian
_______________________________________________ Phone_________________________
Adults
living in the household: Men, how many? _____________ Women, how many? ____________
Children
living in the household: Boys, how many? __________ Ages:
____________________________
Girls, how many? __________ Ages:
____________________________
Is
there anyone in the household allergic to pets? Yes No
Explain ____________________________
Is
there anyone in the household that is nervous or unsure of cats? Yes No Explain
_______________
Do you
have children in the neighborhood that visit? Yes No
Ages: ____________________________
PET HISTORY -
EXPERIENCE
Current Pets
Type Name Age Sex Spayed/Neutered Where is the pet kept?
1. ______________ ______________ ________ _______ Yes No
In Out Both
How long have you owned this pet? ______________________
2.
______________ ______________ ________
_______ Yes No
In Out Both How long have you owned this pet?
_________________________
Past Pets
Type Name Spayed/Neutered
Where was the pet kept? How
long owned?
1. _____________ __________________ Yes No
In Out Both
______________
What
happened to this pet?
__________________________________________________________________
2. _____________ __________________ Yes No
In Out Both
______________
What
happened to this pet?
__________________________________________________________________
What’s
your cat experience? First-time owner Have had one or two Knowledgeable & Experienced
Why do
you want to adopt this cat?
___________________________________________________________
Will
the cat you are wanting to adopt be: Strictly indoors Inside/Outside Strictly outdoors
What
will you do with the cat when you leave town?
______________________________________________
What
will you do with the cat if you move?
_____________________________________________________
If the
cat becomes sick or injured will you take it immediately to a vet? Yes No Depends
Can you
handle the smell and the daily up keep of a litter-box? Yes No
If the
cat refuses to use the litter box what would you do? _________________________________________
Who
will be the primary care-taker of this cat?
__________________________________________________
YOUR HOUSEHOLD
Time
away from the animal: Home all day Out part-time Away 7-10 hours daily
Household
activity level: Quiet Active Very active
Home
atmosphere: Grand Central Station Some activity Zen-Garden serene
HOPES AND EXPECTATIONS
Age: 8-16 weeks 4-12 months 1-3 years Older No preference
Coat: Short Medium Long No preference
Sex: Male Female No preference
Temperament
and Activity level (check all that apply)
Zippy, high energy, kitten-like Mellow, easy going
Other:
____________________________________________________
I
prefer a cat that: Will enjoy living indoors only
Will enjoy being outside while I’m with
him/her
Will come and go independently
Will enjoy living outside only
As far
as scratching: I would trim cat’s nails regularly
I would provide a scratching post
I would train cat not to scratch furniture,
if necessary
I plan on declawing (nothing wrong with this,
cat must be strictly indoor cat only)
Kitty
habits I just can’t tolerate are: ___________________________________________________________
I would
like more information about:
__________________________________________________________
Example: cat to cat intro, dog intro, litter-box training, age at
which cats can go outside, etc.
It
sometimes takes a cat longer to adjust to a home that already has resident kids,
dogs and cats. In some cases the new
cat and other animals may never bond, only tolerate each other. How will you handle this? ________
________________________________________________________________________________________
________________________________________________________________________________________
RELEASE AND
AGREEMENT
I
certify that the information I have given is true, and I authorize the CBBSB
Animal Shelter to contact veterinarians, landlords and references to
investigate all statements in this application, and to do follow-up property
checks.
Signature
__________________________________________________ Date _________________________
STAFF USE ONLY
The
best match would be: Animal
I.D#___________________ Name
______________________
Pending
Adoption: Yes, Date ___________ No Keep on File
Landlord Permission: Obtained, Date ____________ Denied
Parental
Permission: Obtained, Must be in Person, Date ____________ Denied
I have
reviewed the following cat-related issues with the potential adopter:
Cat/cat intro. Vaccinations Cats and children
Cat / dog intro. Age at which it can go outside Declawing
Litter-box issues Identification, lost and found Food and nutrition
Cats and change Providing scratch surfaces Behavior Helpline call us with any
questions or problems!!!!!
Applicant
approved: Yes No If
no, why? _________________________________________________
Applicant
notified of decision: Yes No
Employee
reviewing application: ________ Date _________ 2nd Employee
_________ Date _________