Adoption Application
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First Name
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Middle Initial
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Last Name
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Date of Birth
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Spouse First Name
Spouse Middle Initial
Spouse Last Name
Spouse Date of Birth
Primary cat you're interested in (cats not listed in menu are no longer available for adoption)
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Ashes / Onyx (Cat - U2021001)
Michelle (Cat - S2019211)
Taz (Cat - U2021010)
Why are you interested in this cat?
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Other cats you're interested in
Ashes / Onyx (Cat - U2021001)
Michelle (Cat - S2019211)
Taz (Cat - U2021010)
Your Street
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City
*
State
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AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
Home Telephone Number
Mobile Phone Number
Your Email Address
*
Employment Status
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Full-time
Part-time
Retired
Unemployed
If employed, who is your employer?
Number of adults in home?
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1
2
3
4
5+
Number of children in home?
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0
1
2
3
4
5+
What are their ages?
Do you rent or own?
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Own
Rent
If renting, what is your landlords name and number?
Have you had any animals in the last 5 years?
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Yes
No
If yes, list name, age, type (dog, cat, etc), and whether they are alive or deceased
If you've had cats, have they been indoor, outdoor, or both?
Indoor
Outdoor
Both
Have you ever declawed a cat?
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No
Yes
If yes, please explain why.
If you moved to the countryside would you let your cat outside?
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No
Yes
Veterinary References for pets from last 5 years (Enter name, address, phone #)
*
How did you find Ten Lives?
Facebook
Instagram
Petfinder
PetSmart
Friend
Family
Other
By signing this application, I agree to the following: All statements made on this application are truthful; I have made no false statement with regard to family members in household, status of my home ownership and any other statements made on this application. If approved to meet the applied for cat, I understand and acknowledge that said cat may bite/scratch at the initial meet and greet. I agree that Ten Lives Cat Rescue and/or Ten Lives volunteers are not liable for any injury suffered at a meet and greet, as Ten Lives Cat Rescue cannot guarantee the behavior of said cat.
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I agree
I disagree
Electronic Signature
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