Name of cat/kitten desired (include case # if known)
Your Name (First & Last)
Your Age
Your Spouse's or Significant Other's Name (if applicable)
Your Spouse's or Significant Other's Age (if applicable)
Address
City, State, Zip
Your Employer
Your Spouse's or Significant Other's Employer (if applicable)
Email Address
Home Phone
Cell Phone
Work Phone

How many adults live in your household?
How many children live in your household?
Please list the ages of all children in the household (if applicable)
Do you use a babysitter?	Select one Yes No
If so, have you discussed how the babysitter feels about cats?
What type of home do you live in?	Select one House Apartment Mobile Home Condo / Townhome Other (please explain)
If other, please explain
Do you own or rent?	Select one Own Rent
If rent/lease, name of landlord/complex
Phone number of landlord/complex
Amount of deposit required by your landlord for pets
Have you paid your pet deposit yet?	Select one Yes No
Are you planning on moving soon?	Select one Yes No
If you do move, what would you do with your pets?
What would you do if you need to move to a place that does not allow pets?

What characteristics are you looking for in a cat or kitten?
Why did you decide to adopt a cat?

Do you want a cat for? (check all that apply)	House Pet	Family Pet	Child's Pet	Companion for elderly family member
	Gift	Company for other pet	Mouser	Barn Cat
	Other	Explain:
Is the pet for?	Inside Only    Outside Only  Inside/Outside

Where will the cat be during the day?
Where will the cat stay at night?
Where will the cat stay when you are away from home?
Do you intend to declaw?
Do you have a doggie door?	Select one Yes No
How many hours a day will the cat/kitten be alone?
How does everyone in the household feel about owning a cat/kitten?
How long do you think it should take for a cat/kitten to adjust to your home?
Are you familiar with local regulations regarding licensing and leashing of pets?
How much do you anticipate spending yearly for food, toys, medical care, grooming and other expenses for this pet?
If the pet becomes seriously ill or injured and needs extensive veterinary care, what would you do?
What would you do if the pet exhibits destructive behavior?
Where do you intend on placing the litter box?
What brand(s) wet/dry of food do you intend to feed your cat or kitten?

Are you familiar with the following feline diseases:	Feline Leukemia	Feline Aids	FIP	Urinary Tract Infection
	Stomatitis	Heartworms	Ringworm	Vaccine Related Fiber Sarcoma

What would you consider a good reason to give up this pet?
If you could no longer care for this pet, what would you do?
Do you have a regular veterinarian?	Select one Yes No
If yes, Name of vet clinic
Phone number of vet clinic
Please check to authorize permission to request information from your veterinarian	Yes     No
Pets Currently Owned
Do you currently have any pet?	Select one Yes No
Pet #1
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age
Where is this pet kept?
Date of last vet visit
Pet #2
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age
Where is this pet kept?
Date of last vet visit
Pet #3
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age
Where is this pet kept?
Date of last vet visit
Pet #4
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age
Where is this pet kept?
Date of last vet visit
Pet #5
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age
Where is this pet kept?
Date of last vet visit
Pets Previously Owned
Have you had previous pets?
Previous Pet #1
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age when last with you
Where was this pet kept?
Date of last vet visit
What happened to this pet?
Previous Pet #2
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age when last with you
Where was this pet kept?
Date of last vet visit
What happened to this pet?
Previous Pet #3
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age when last with you
Where was this pet kept?
Date of last vet visit
What happened to this pet?
Previous Pet #4
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age when last with you
Where was this pet kept?
Date of last vet visit
What happened to this pet?
Previous Pet #5
Name
Breed/Description
Spayed/Neutered?	Select one Yes No
Male or Female?	Select one Male Female
Age when last with you
Where was this pet kept?
Date of last vet visit
What happened to this pet?
I certify that the above information is true and understand that any false information may result in denial of this application This application is the property of SMART. SMART reserves the right to decline any adoption. (Check box if agreed)

 Please answer this question:

What type of animal do you see in the picture below?  

Please be sure you have answered all questions prior to hitting the Submit Button.