Print your name

Print your street address and apt #

Print your city, state, zip code

Home Phone

Cell Phone

Work Phone

Print your e-mail address

Do you prefer to be contacted by:     E-Mail      US Mail  

How long have you lived at this address?     months      years  

How did you find out about Francis's Friends?

What is your age?

Do your own or rent your home?     Own      Rent  

When does your lease expire?

If renting, have you confirmed that pets are permitted in your builidng?     Yes        No  

Are you adopting for yourself or for someone else?

Do you know that cats can live 15 to 20 years?     Yes      No  

Are you ready to make a long term commitment?     Yes      No  

Do you have screens on your windows?     Yes      No  

Do you have a terrace?     Yes      No  

If you have a terrace, does it have a screen door?     Yes      No  

If you have a terrace, is it enclosed?     Yes      No  

Do you have a backyard?     Yes      No  

Occupation

Present Employer

How long have you been with this company?     months      years  

Present employer's address

Name and Phone Number of a Business Reference

Previous Employer

How long were you with this company?     months      years  

Does your job require extensive travel?     Yes      No  

What arrangements will you make for your pet's care when away on business or vacation?

What arrangements will you make for the care of your pet in case of an emergency?

Name of a personal reference

Address of personal reference

City, State, Zip Code of a personal reference

Phone number of personal reference

Relationship of personal reference

Do you have a husband, wife, partner or children living in your home?     Yes      No  

Specify?

How old are they?

Does anyone in your family have allergies to animals?     Yes      No  

Have you had pets before?     Yes      No  

If yes, please specify?     Dogs      Cats      Other - specify  

Where is this pet(s) now?

If the pet was relinquished, why and how?

Are there any other pets in your home now (please indicate number)?

Is your pet spayed neutered?     Yes      No  

Would you prefer to adopt a de-clawed cat?     Yes      No - not necessary  

Do you want a cat that can catch mice?     Yes      No - not necessary  

Veterinarian's name

Street address

City, State, Zip Code

Phone number

Are you interested in receiving information on new pet products which we think are important?     Yes      No  

(1) Unless otherwise indicated on their health care record, cats and kittens are not vaccinated for leukemia or rabies. I understand that if I want these vaccinations I am responsible to obtain them for my cat or kitten. (2) Occasionally cats/kittens may develop ringworm which is a skin fungus similar to athlete's foot. It is differentially transferable to humans, that is, some people may contract it from cats/kittens. We urge you to check with your physician about the advisability of adopting a cat/kitten should your immune system be compromised.
I understand the above advisory pertaining to leukemia and rabies vaccinations and the risks of ringworm.     Yes  

By submitting this application, I testify that the above information is true and I authorize Francis's Friends Inc. to contact those listed above.  I understand that the completion of this form is the first step in the adoption process and does not guarantee an adoption.  Should an adoption take place, Francis’s Friends reserves the right to make an in-home screening visit and to deliver the cat(s) to ensure that I will provide a hazard free home.