Cat Adoption Application Your Name*Physical Address*City*Postal Code*Mailing Address if different from aboveHome Phone*Cell PhoneEmail* Do you have a specific ICAN animal in mind? Tell us its name*Who are you adopting this animal for?* Self Relative Friend Child Other Have all members of your household been introduced to the animal? Yes No Number of Adults at home? (18+ yrs)*Please enter a number from 1 to 10.Number of Young Children at home? (0-7 yrs)*Please enter a number from 0 to 20.Number of Children at home? (8-17 yrs)*Please enter a number from 0 to 20.Are children experienced with small animals?* Yes No Any severe allergies to cats in your family?* Yes No Don't know How busy is your family?* Very A little Sometimes Not at all How would you describe yourself?* Loud Calm Quiet How would you describe your household?* Loud Calm Quiet Are you planning on the following in the next month? Moving, Holiday, Major Change in Schedule*Do you have a family vet? Yes No Not yet Type of home?* House Apartment Acreage Rent or own?* Rent Rent Share Own Own Share If you rent do you have the landlord’s permission to have pets? Please provide a copy of your rental agreement.* Yes No Landlord’s name, phone number and email address*Outside areas? e.g. Balcony, Patio, Yard, ForestYour street? Busy Quiet I am wanting this animal to be a:* Companion Companion for Pet Mouser Barn Cat Who will be the cat’s primary caretaker?Where will your cat stay during the day?* Outside Inside Both Where will your cat stay during the night?* Outside Inside Both Other Where will your cat stay during vacations? At home with care Boarded With a friend/relative Have you had cats before? Yes No What happened to them?Have you ever surrendered an animal to a shelter? Yes No Why?Do you have other cats? Yes No Tell us about your Cat Spayed Female Intact Female Neutered Male Intact Male Age of your CatYour cats Temperament with other cats Friendly Disinterested Afraid Aggressive Not Sure Do you have any other cats? Please select below. Spayed Female Intact Female Neutered Male Intact Male Age of your 2nd CatTemperament of your 2nd cat with other cats Friendly Disinterested Afraid Aggressive Not Sure Do you have a 3rd cat? Spayed Female Intact Female Neutered Male Intact Male Age of your 3rd CatTemperament of your 3rd cat with other cats Friendly Disinterested Afraid Aggressive Not Sure Do you have other animals?* Yes No What other animals do you have?Temperament with cats Friendly Disinterested Afraid Aggressive Not Sure Please specify type and breed of your animal #2Temperament with cats Friendly Disinterested Afraid Aggressive Not Sure References are required - Please list two references who can comment on your character and experience with animals. REFERENCES MUST NOT BE FAMILY MEMBERSReference 1*Please include Name, Phone number and Relationship to this personReference 2*Please include Name, Phone number and Relationship to this personDesired AnimalDesired Sex of the cat you want to adopt Male Female Either Coat Short Medium Long Any Age (Please note that the age of many cats who come to us are estimated) Kitten Adult Senior Any Breed, Type, or ColorBe Friendly with people/pets Very Important Important Not Important Be cuddly, affectionate with you Very Important Important Not Important Be calm and mellow Very Important Important Not Important Be active and playful Very Important Important Not Important Never scratch the furniture Very Important Important Not Important Always use the litterbox Very Important Important Not Important Never show aggressive behaviour Very Important Important Not Important Problems you are willing to work onI'm interested in working on problems Yes I am not interested in/knowledgeable enough to work on problems Depends on problem I might if I have someone to advise me Behavioural Problems Litterbox Scratching Furniture Both Socialization Problems Fearful Shyness Nervousness Any of the above Under what conditions would you return your cat to ICAN? (e.g. Aggressive, Too timid, Wrong decision, Scratching furniture, Litter box problem, Does not get along with other pets, Too costly, Not enough time, Cat's health problems, New baby)How long will you give your new cat to adapt to his/her new surroundings? Less than a week One to two weeks One Month As long as it takes AgreementsI am 19 years of age or older* Yes No Have you ever been investigated for neglect or cruelty to animals? Yes No Are you willing to have an ICAN representative do a home visit by appointment? Yes No Tick the checkboxes below to indicate to us you completely understand and agree to the following statements.* It is my responsibility to see and evaluate this kitten/cat for myself before agreeing to adoption This kitten/cat will reside in my home as a companion. I will provide him/her with adequate food, water, shelter, affection, socialization and medical care I will not sell, trade, give away or otherwise dispose of this kitten/cat. If at any time I am unable OR unwilling to care for this kitten/cat, I agree to contact ICAN to return him/her to ICAN or to discuss finding him/her a new home ICAN is in no way liable or responsible for any damage, accident or injury resulting from the placement of a kitten/cat into my household ICAN cannot be held responsible for any health or temperament problems of this kitten/cat ICAN cannot be held responsible for any unforeseen medical conditions that may arise after adoption Please add any other information that might help us match you with the right cat.ICAN DISCLAIMER Falsified information will lead to automatic rejection of the application. ICAN reserves the right to refuse any applicant. I declare that all information provided in this application is true and complete. I will provide photo I.D. before the adoption can be completed. ICAN exercises due diligence and will disclose all known previous history for each rescue animal we place. ICAN is not liable for any unforeseen behaviors or medical issues that might arise after adoption. ICAN does our best to access and provide as much information as possible on each animal that comes into our care and expects that all Adopters are aware that new situations may have the potential to bring out unknown issues after adoption. ICAN also ask that all Adopters agree not to surrender any animal we place with them for euthanasia unless that is the only option or course of treatment recommended and provided by a licensed Veterinarian. THANK YOU FOR COMPLETING THIS APPLICATION FORM. Note: following submission of this adoption application, you will be contacted to come into the ICAN shelter to complete and sign additional documents if required. THIS INFORMATION WILL HELP US MATCH YOU WITH THE RIGHT CAT FOR YOUR FAMILY. Captcha Δ
