44793 Harrison Road

Spartansburg, PA  16434

Phone: 814.827.8270

E-mail: info@brightfuturesfarm.org

Feline Placement Application

Please email, fax or mail your completed application to us. For fax, please call first. Email and postal address are in the top right corner of this form.

ANIMAL NAME/ID#:_____________________________

NAME:_______________________________________

ADDRESS:_____________________________________________________________

CITY: _________________________________________________ STATE: _____ ZIP:______________

HOME PHONE #:_______________________ CELL PHONE #:_________________________________

DRIVER'S LICENSE NUMBER:_________________________ DATE OF BIRTH:__________________

E-MAIL ADDRESS:___________________________________

Please answer the following questions (check a box where appropriate).

1)  Check one:  □ Rent    □ Live with parents    □ Own      

      Type of residence (house, apt, etc.):____________

1a) If rent, Landlord’s name_______________ / phone # if applicable:__________________

2) I have a veterinarian that my pet uses:   □ No     □ Yes

Name:______________________________________ Phone:_______________________

3) Please list the pets you’ve owned in the last five years, below:

4) I am adopting this cat for… □ Myself     □ My child(ren)     □ My family     □ A friend      □ A relative

5) A member of my household is allergic to cats:   □ No      □ Yes       who:_____________________________

6) I prefer a:   □  Male     □ Female      □Either

7) I like cats that have: □ Short hair      □ Medium hair     □ Long hair      □ Any

8) My cat needs to get along with other cats:   □ No      □  Yes

            Or dogs / other animals: □ No      □ Yes  type: _______________________________________________

9) I have:  □  indoor cats     □ indoor/outdoor cats     □ dog(s)    □  other pets    □  livestock

    How many of each? _____________________________________________________________________

10) I need a cat that will tolerate being alone hours a day.    □ No      □ Yes

11) I prefer a cat that will enjoy:   □Living indoors    □  Living indoors/supervised time outdoors      □ Living outdoors                            

               □ Living in our barn

12) My ideal cat would: ______________________________________________________________________

13) Bad kitty habits that I just can't tolerate are:__________________________________________________

__________________________________________________________________________________________

14) I share my home with ______children and their ages are:__________________

       I also share my home with: _____adults.

15) I have children who visit frequently    □ No      □ Yes  Their ages are:____________________________

16) I would like a cat who: (check all that apply)

□ Plays gently Is fairly active Is an enthusiastic player

□ Loves everyone Prefers mostly family Needs encouragement w/strangers

□ Is a cuddler Enjoys a little lap time Is more independent

□ Is quiet Talks occasionally Is a chatterbox

17) The noise / activity level in my home is usually:  □  Low    □  Medium     □ High

18) When it comes to keeping a clean and tidy house I am:   □Easy-going    □Very particular      □Particular

19) I enjoy brushing / grooming my pets:   □Never      □1-2 times/week      □Light daily      □Heavy daily

Thank you for this information!

Please sign below and date your application

____________________________________________________________ date: _______________________

your signature