First Name*

Last Name*

Email*

Phone Number*

Street Address:*

City:*

State:*

Zip Code:1

Date of Birth:*

Employment Status:*

Number of Adults in Home:*

Number of Children in Home and Ages:*

Do You Own or Rent?*

How long have you resided at current address?*

If you rent, please provide landlord name and telephone number:

Does anyone in your home have allergies to pets or asthma?*
Choose one: Yes No

If yes, please describe and indicate what steps they will take to be able to live with this cat.

Have you had pets before?
Choose all that apply: Cats Dogs Others None

Do you currently have pets in your home? If so, please provide the type of pet(s) and the number of pets.*

If you currently have other pets, what steps will you take to introduce your new pet into your home?

Name of your current veterinarian: *Please call your vet's office and ask them to release your pet records for a vet check within the next 24-48 hours*

Current Vet Phone Number:

Previous vet name and telephone number:

Are your current pets spayed/neutered?*
Choose one: Spayed Neutered (All) Spayed/Neutered (Some) Not Spayed/Neutered Not Applicable (No current pets)

Are your current pets current on vaccines?*
Choose one: Yes No N/A (no pets)

A pet is a lifetime commitment. Can you commit to the care of this pet for 10-20 years?*
Choose one: Yes No

Have you ever surrendered a pet?*
Choose one: Yes No

If you have ever surrendered a pet a pet, please explain why:

Please list a personal reference (not family) and their phone number.*

If you are applying for a specific cat/kitten, please select the name of the cat/kitten. Note, availability of specific animals may change. Approval of the application does not mean that you are guaranteed that specific cat/kitten until you have met them, completed any necessary paperwork and paid the adoption fee.
Choose an animal: Collette Cosmelina Danny Darla Debbie Gibson Donnie Gambit Kiara Lincoln Maggie Mia Molly Muffin Parker Percy Poe Polly Skipper Smokey Tiffany Tippy

Please understand that if you are approved for the adoption of a Whiskers of Winfield cat, you will agree to the following: My cat will be kept indoors at all times. If this adoption does not work out, I will notify and return this cat to Whiskers of Winfield. For kittens under the spay/neuter age. I agree I will have my cat spayed/neutered as soon as he/she is old enough. A voucher for a spay/neuter at Four Seasons Animal Hospital will be provided with the adoption fee. If I choose to use another veterinarian, I will provide WOW proof of spay/neuter by the time my pet has reached 6 months of age. I hereby authorize the release to WOW your entire veterinary records for the animals I have. I authorize WOW to conduct a rental and personal reference check and authorize the release of this information. I certify that the information I have supplied in this application is true and understand that false information may void this application and or/ adoption. *

Typing my name in this field shall serve as my signature:*

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