Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What is your age? *

Under 21

21-30

31-50

51-60

61-75

76+

Are you employed/have a steady income to support the costs associated with pet ownership? *

Employed part-time

Employed full-time

Student

Other

Do you rent or own the house/apartment you live in? *

I rent my home

I own my home

Do you have children? *

Yes

No

If yes, check the option that applies to you.

My children live at home

They do not live at home (but may visit)

Have you adopted a pet before? *

Yes

No

Are you familiar with how to help a new addition settle into your home? *

Yes

No

Are you willing to deal with potential temporary behavioural issues during an adjustment period? (These issues may include inappropriate toileting, spraying, nervousness, etc.) *

Yes

No

Have you ever consulted your vet for assistance with behavioural issues? *

Yes

No

Have you ever previously given up or re-homed a pet due to behavioral problems? *

Yes

No

Have you ever been required to put a previous pet to sleep due to costly medical care? *

Yes

No

Do you have a lifestyle/job that takes you away from home frequently? *

Yes

No

Are they still part of your family? *

Yes

No

N/A (this will be my first pet)

Are your pets declawed? *

Yes

No

N/A (I have no pets currently)

Would you declaw a new pet introduced to your home and family? *

Yes

No

Unsure

Are your pets altered (spayed/neutered)? *

Yes

No

N/A (I have no pets currently)

Will the cat that you are applying for be: *

Indoor only

Indoor/outdoor

Strictly outdoor

Are your current cats: *

Indoor only

Indoor/outdoor

Outdoor only

N/A (I don't currently have a cat)

Do any of your pets have any known illnesses or parasites? (Distemper, Parvo, Mange, Ringworm, FIV/FeLV, etc.) *

Yes

No

N/A (I have no pets currently)

Veterinarian's Phone Number *

(###)

###

####

Clinic Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Will you be using the same Veterinary Clinic listed above to care for a newly adopted cat? *

Yes

No

Veterinarian's Phone Number

(###)

###

####

Clinic Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are the pets in your home up to date with vaccinations? *

Yes

No

N/A (I have no pets currently)

Do you have up-to-date vet records? (Vaccine certificates, spay/neuter certificate, microchip, etc.) *

Yes

No

N/A (this will be my first pet)

Do you have your current pets registered for pet insurance? *

Yes

No

N/A (I have no pets currently)

Were your previous cats: *

Indoor only

Indoor/outdoor

Outdoor only

N/A (I never had cats previously)

Were your previous cats: *

Childhood pets

Owned as an adult

N/A (this will be my first cat)

I confirm I have contacted my vet(s) and given them permission to speak to any representatives of Rags to Riches Cat Rescue about my patient history. *

Yes

No (application won't be processed until this is done)