Street address

City State Zip

Home phone Cell phone Work phone

Email address Would you like to be on our mailing list Yes No

What type of cat are you looking for? Colors?

Age preference? Gender?

How many cats do you now have?

Who will be the primary caretaker for this pet?

Please describe the household

List all children's ages

If there are no children currently in the household, do other children visit often? Yes No

Do you own or rent your home? Own Rent

Is it a house or apartment? House Apartment

Country or city setting? Country City

If you rent, please provide the name and phone number of your landlord

Please describe the cat's living situation
Inside Outside Mouser FamilyPet Business Residence Other

Do you have any other pets at home? Yes No

If yes, please describe

Are they spayed or neutered? Yes No

Are they current on their vaccinations? Yes No

Please provide the name and phone number of your Veterinarian

Do you plan on de-clawing the cat? Yes No

How long did your last pet(s) live ?

Are you aware that a cat can live up to 20 years or more with good nutrition and medical care? Yes No

Are you willing to make that commitment to a cat that you adopt from the Hi Tor Animal Care Center? Yes No

In order to prevent behavioral problems and reduce the number of unwanted animals, we require that all our animals are spayed and neutered. Do you agree with this medical procedure? Yes No

If not, what are your concerns ?

Please provide us with the names and phone numbers of two acquaintances as references

Signature of interested adopter