1116-A 8th St. #61
Manhattan
Beach, CA 90266
www.noahsbark.org
Pet Interested in:____________
Date:____________
PRE-ADOPTION
QUESTIONNAIRE
Name
_______________________________
Occupation: ____________
Spouse/Sig.
Other: _____________________
Occupation: ____________
Roommate(s):_____________________ Children\u2019s Ages: ____________
Address
______________________ City
______________ Zip ______
Home
Phone ( ) _________ Business Phone ( ) ___________
Cell/Pager
( )___________ E-Mail ______________________
How
long have you been at your current residence?_____________
Do
you live in a: House____ Apartment ___ Condo ____ Other _____
Do
you: Own ___ Rent ___ Share rent or ownership ____
Does
your landlord approve of you adopting a pet?
Yes ___ No ___
Don\u2019t know ______
Have
all adults in your house agreed to adopt a cat? Yes ___ No ____
Don\u2019t know _____
Life
can change suddenly. What would happen
to the cat if:
Your relationship changed?
__________________________________
You became unable to care for it?
_____________________________
Do
you have a cat or dog door? Yes
____ No ____ Where?___________
Does
the cat have access to a balcony or patio?
Yes ___ No ___
Do
all windows or sliding doors have secure screens? Yes ___ No___
Don\u2019t know _____
How
long will the cat be allowed outdoors? _________________________
Under
what circumstances will the cat be allowed outdoors? Be specific
___________________________________________________________
How
long will the cat be kept indoors? ____________________________
Where
will the cat\u2019s litterbox be located? ___________________________
Will
you allow a Noah\u2019s B\u2019ark volunteer to inspect your home? __________
Have
you ever owned a cat before? _______
When?__________________
What
happened to it? Be specific. __________________________________
Have
you ever owned a declawed cat? ____
When? __________________
Would
you like to declaw this cat? Yes/No/Maybe ______________
What
other animals do you presently own? ________________________
Are
these animals spayed or neutered? Yes/No/Don\u2019t
know ___________
Are
their vaccinations current? Yes/No/Don\u2019t know __________________
Have
your cats been tested for Feline Leukemia and Feline Aids?
Yes/No/Don\u2019t know ______________
Can
you afford regular veterinary care for this cat, including, yearly
vaccinations, yearly physical exams, dental care, etc? ($150 or more)
Yes/No ____________
Can
you afford serious injury or illness costs?
($500 or more)
Yes/No ____________
Where
will the cat stay when you travel or on vacation:
Home
___ Kennel ___ Live-in Sitter ___
Friend/Relative ___ Other (Be specific)
___________________________________________________
If
you move (house or apartment), will the cat most likely be: indoor ____,
indoor/outdoor_____,
outdoor______.
What
reasons would you give up the cat?
Allergy
___ New Baby ___ Moving ___
Illness ___ Divorce/Separation __
Not
getting along with other pets in the house ___
Not getting along with new person in the house ___ Other (be apecific) ______________________
What
would you do if:
The
cat suddenly stopped using the litterbox? ________________________
Clawed
your good furniture (like leather)? ___________________________
Kept
trying to get outside?________________________________________
Our
volunteers will make every effort to help you if these problems occur.
What
breed/color/personality of cat do you want? _____________________
Why
are you adopting a cat?
Companion
for you___ Companion for another pet ___ Child wants a cat __
Gift
for another person ___ Other (be
specific) _______________________
Do
you have any specific concerns/questions about adopting a cat (average lifespan
is 15 years or longer)?
___________________________________
By
my signature I certify that my answers are true and correct and that any false
information may result in nullifying the adoption. THIS IS AN ADOPTION, NOT A SALE, and Noah\u2019s B\u2019ark reserves the
right to refuse adoption to anyone for any reason. This questionnaire becomes part of Noah\u2019s B\u2019ark permanent record
or contract.
Signature
____________________________
Date_______
Volunteer
_________________________________________
PLEASE NOTE: Adoptions are not done on a first come first serve basis. Filling out an application DOES NOT guarantee an adoption. We have thoroughly evaluated all of the animals in our care, and try very hard to match the right pet to the right person and situation.
If
we do not call or email you within 3-4 days of receiving your application it
means that either:
1)
The
pet was adopted by another applicant, or
2)
We felt the situation presented on the application was not the right placement
for that particular pet.
Thank you
for your understanding,
Noah\u2019s
B\u2019ark