General Information

*Date: (MM/DD/YYYY)

*First Name:        *Last Name:

*Street:

*City:      *State:      *Zip Code:

Phone:
Home:      Work:      Cell:
May we call you at work?    Yes        No

Occupation:

Primary Email:        Secondary Email:

How would you prefer to be contacted?    By Phone        By Email

*Do all the members of the household know you plan to adopt?   Yes        No

*Are you over 18?    Yes        No

Guardian's Name:

Guardian's Phone Number:

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Household Info
Do you rent or own your home?    Rent        Own
(If you are living with parents or relatives, you are considered to be renting)

If you rent or board please provide the following:
Landlord's Name:

Landlord's Phone Number:

Number of people in your household:

Adults

Children

Ages of children:

Is anyone in your household allergic to cats?    Yes        No        Not Sure

Who will be the cat's primary caretaker?

How many hours a day will your cat spend alone?

Will your cat be allowed outdoors?    Yes        No        Not Sure

Will you declaw your cat?    Yes        No        Not Sure

If you must move, will you take your pet(s) with you?    Yes        No        Not Sure

Can you afford medicial care, including yearly vaccination updates?    Yes        No        Not Sure

What will you do if your cat scratches your furniture?


What will you do if your cat bites or scratches someone?


How will your new cat(s) spend its/their days?


Have you adopted from MRFRS before?    Yes        No        Not Sure

Have you ever surrendered a cat to MRFRS?    Yes        No        Not Sure

Have you previously or do you presently have a pet?    Yes        No        Not Sure

Name of pet:		Species:
Deceased?   Yes        No Cause?
Name of pet:		Species:
Deceased?   Yes        No Cause?
Name of pet:		Species:
Deceased?   Yes        No Cause?
Name of pet:		Species:
Deceased?   Yes        No Cause?

Veterinarian's Name:
Location:        Phone Number:

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References
Please provide three references (friends, neighbors, coworkers, etc.). These people should not be related to you and should have known you for at least one year.

Name:			Relationship:			Day Phone :
Email:						Eve Phone :
Name:			Relationship:			Day Phone :
Email:						Eve Phone :
Name:			Relationship:			Day Phone :
Email:						Eve Phone :

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The information I/we have provided is true. I understand that any misrepresentation of the facts may result in my losing adoption privileges.

*Signature:	*Date: (MM/DD/YYYY)
MRFRS reserves the right to deny any application without explaination. All decisions are final.

      

NOTE: All fields with a red asterisk (*) is required in order for the form to be submitted to us.

(If there is a problem with the adoption form, please email the webmistress at: webmistress@mrfrs.org)