Stray Cat Blues, Inc

Stray Cat Blues, Inc.

Barn Cat Adoption Application

Top of Form

Name:

Home Phone: Work Phone:

Address:

City: State: Zip:

Email:

Type (age, gender) and number of cat(s) you are interested in:

Name of cat(s) you are interested in:

Name and phone number of a reference who does not live with you.

Please provide the name and phone number of your small animal veterinarian.

Please provide the name and phone number of your large animal veterinarian.

Do you agree to let Stray Cat Blues visit your home/farm by appointment? Yes No.

Who will be responsible for the cat's care?

Do you own or rent/board your residence?

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

What is the size and description of your property?

How far from the road/traffic is your barn located?

Volume of traffic light moderate heavy
What is the speed limit?

Please describe those pets that are currently with you (type, age, sex, altered status, how long owned).

If you have a dog, is it permitted to run loose? yes no
If yes, what provisions will you make to protect the cat(s)?

Please describe those pets that are no longer with you (type, age, sex, altered status, how long owned)

What happened to the pets who are no longer with you?

Reason for wanting a cat?

Do you intend to declaw your cat(s)?Yes No.

Do you understand that barn cats adopted through Stray Cat Blues must receive vaccinations as required by State law? Yes No.

15. How did you hear about Stray Cat Blues?

By submitting this form I authorize my veterinarian to release to Stray Cat Blues, Inc. information about my veterinary records of any and all animals I own or have owned. I also certify that all the information in the application is true and correct and I understand that false information may void the application. Approved applicants will be contacted by a Stray Cat Blues, Inc. representative.