First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Cell Phone*
Alt Email
Text/Pager Email
Please phonetically pronounce your first/last name
Select the name of the cat you are applying for: Choose an animal: ADELE ALEX ARCHIE ARLO ARLO (Hound) ARMARETTO ASHE ATHENA AVA BEAR BEE BELLA BILLI BINX BIRCH BLUEY BRIXTON BROWNIE BURTON CAL CALI CASSEROLE CHIEF AKA SKUNK COCO CODY COMET CUTTER CYNTHIA DAPHNE DaVINCI DELILAH(terrier) DIAMOND DINO DOGULA DOLLY EBONY EEYORE Eleanor ELIJAH ENZO FERGAL aka RAMBO FERN FERRIS FINLO FOZZY BEAR GENERIC KITTEN GHOST GOUDA GREEN BEAN GREY GROVER HAYWOOD HENRY HOLLY HOPE JR KATE KENNEDY KREME nka Maddie LADY LASAGNA LAYLA LEE LINDA LOKI LOU LOUIE MAC & CHEESE MADISON MAGGIE (SHIRLEY - Boston Terrier mix) MASON MATSON MAUI MEDUSA MITCHELL MOON PIE NAOMI OAKLEY ODIN OREO PAMELA PAW PAW PEAR PECAN PIP RAIN RED REUBEN ROSCOE SADIE SALVADOR SAMMY SAPPHIRE SARAH SCOUT SKIPPER SKULLY SOPHIE STELLINE SUMMER TEDDY TEDDY BEAR TRISH TULIP TULIP VEGAS WHISKEY WINK WINONA XYLA YANCEY YEOL ZANDY
If not applying for a specific cat, please tell us what you are looking for in adopting one of our cats. PLEASE TELL US IF YOU ARE LOOKING TO ADOPT MORE THAN ONE CAT
How did you hear about us?
What is your date of birth? (**We DO NOT adopt or allow someone to foster under 21 years of age**)*
What is the name of your employer and current job position title? (Please enter self, retired, homemaker/stay-at-home parent if appropriate)*
Employed since? (MO/YR)
Please list ALL members of your household (include NAME, AGE, and relationship to you)*
Does any member of your family have any allergies to animals? Choose one: Yes No
Please provide details if allergies are a consideration.
What type of home do you live in?* Choose one: Apartment Condominium House
Do you own your home, rent your home or live with your parents? * Choose one: Live with Parents Own Rent
If renting, please enter your landlord's name and phone number. If you are living with family/parents please provide a contact for the home owner.
How many are cats are currently part of the family? * Choose one: None (0) One (1) Two (2) Three (3) Four or More (4+)
How many dogs are currently part of the family? * Choose one: None (0) One (1) Two (2) Three (3) Four or More (4+)
Do you have other pets? Please specify.
Please provide your Veterinarian's Name and Phone Number (Current/Past Pets) Enter N/A if this does not apply*
Is the vet account in your name? If not, who is the holder of the account? *
Name, type of animal, age and gender for current pets in the home
Are these pets Spayed/Neutered? Choose one: Yes No
Are these pets up to date on their shots? Choose one: Yes No
Please provide any additional details/comments about your existing pets.
Please describe all the pets you have previously owned in the last 10 years (MUST include Name, Type of Animal, Age, Gender, Year you got the animal, Year deceased, Cause of death or the last year you had the pet and where they are now).
Please provide any additional details/comments about your previous pets.
Please provide a family member as a reference include name, phone # and their relationship to you.*
Please provide NON-FAMILY reference, including name, phone # and their relationship to you.*
Please provide a NON-FAMILY reference, including name, phone # and their relationship to you.*
Do you understand that despite all of our efforts to our cats as healthy as we can, that as living breathing creatures, there will always be a risk that the cat could be harboring an unknown illness and require medical attention after you have adopted it and that this will be YOUR responsibility financially?*
Do you understand that should this animal become sick, YOU will be responsible for all of its medical care after the adoption contracts have been completed? *
Do you understand that should you choose to NOT proceed with proper medical care that this will be considered medical neglect and the adoption contract will become null and void and the animal will become the property of Last Chance Animal Rescue?*
Do you understand that it is possible that this animal may at some point develop and exhibit behaviors (hissing, scratching, destruction of property, etc) that could require professional intervention? It will be your obligation as the adopter to address these concerns and financially assume the responsibility. * Choose one: Yes, I understand and assume responsibility No, I do not understand and do not wish to accept responsibility
Our cats are litter box trained prior to adoption. However, some may experience accidents in their new home setting. Are you willing to work with your new cat and be patient as they acclimate to a new home setting? * Choose one: Yes No
If a behavioral problem arises, what steps will you take to work on it?*
Do you understand that you are making a lifelong commitment to help this animal to transition into its new environment and that you are expected to do whatever it takes to help this animal become an integral part of your family and home?*
Declawing is a painful and torturous procedure that removes 1/3 of the cat's paw. It would be as if someone amputated your fingers at the first knuckle. The front claws are a cat’s primary means of self-defense and escape against the many dangers and predators in our area if the cat were to get outside. Declawed cats are often in chronic pain, and may develop aggression or litterbox problems. If you are looking specifically for a declawed cat, we can help find you a cat that has already been declawed. After reviewing this information, would you be willing to sign a waiver agreeing that you will never declaw your cat? * Choose one: Yes, I agree to never declaw my cat No, I wish to declaw my cat
Our (non-refundable) adoption fee is as followed: CATS over 1 year old age-$125.00, kittens under the age of 1 year-$150.00 and 2 kittens under the age of 1 year- $275.00. Are you financially able to pay? * Choose one: Yes No
Are you aware that we may require a Home Visit to be done before approving this application? * Choose one: Yes No
Would you allow an LCAR representative to visit your cat in their new home?* Choose one: Yes No
• The information I provide will be verified before I am approved for adoption. • False statements or omissions of any of the above information will result in automatic refusal of adoption or confiscation of the animal. • LCAR has the right to refuse the adoption of any pet to any person. • The adoption fee is non-refundable. • I am willing and able to accept financial responsibility for the expenses associated with caring for a cat. This includes preventative health care such as annual check-up and vaccinations as well as emergency medical care in the event of illness or injury. This in addition to regular care with the cost of food, supplies and equipment, toys, and boarding. I fully understand the risks involved with interacting with animals and agree to assume all liability. I agree to hold Last Chance Animal Rescue and any and all of its affiliate programs harmless for any injury(s), loss or damages which I might sustain from interacting with the animals. This waiver includes myself, all of my family members and descendants forever from seeking any legal action whatsoever against Last Chance Animal Rescue or its successor organizations or any representatives thereof. Enter your name and today's date*
Please provide Drivers License #, State of issue and Expiration date.*