Which cat are you applying for?
Name
Address (no P.O.Box)
City,  State, &  Zip
Home Phone
Cell Phone
Email Address
Your Age
How many other adults live in your household?
What are their ages?
How many children live in your household?
What are their ages?
Does any member of your household have an allergy to cats?	Select One Yes No
Does anyone in your household smoke?	Select One Yes No
What type of home do you live in?	Select One House Condo / Townhouse Apartment Duplex / Triplex Mobile Home
Do you own or rent your home?	Select One Own Rent
If you rent, please provide us with the name & phone number of your landlord	Name: Phone:
Do you currently have any pets?	Select One Yes No
If Yes, please provide us with the following information about each pet:

	Type of Pet (ie dog, cat, bird, etc.)	Breed	Gender	Age	Spayed / Neutered?	Fully Vaccinated?
Pet #1
Pet #2
Pet #3
Pet #4
Pet #5
Pet #6

If you currently own pets, how will they adjust to a new cat entering their household?
What kind of pets have you had in the past?
Were they all spayed or neutered?
If not, why not?
What happened to your previous pets?
Have you ever turned a pet into a shelter or rescue organization?
If Yes, please explain the circumstances
Have you had a pet euthanized?
If Yes, please explain the circumstances
Do you currently have a veterinarian?	Select One Yes No
If Yes, please provide us with the name & phone number of your vet's office	Name: Phone:
Describe the cat you are looking for
Why do you want this cat?
Is this your first cat?	Select One Yes No
Will you keep the cat up to date on vaccinations?	Select One Yes No
Do you plan to have this cat declawed?	Select One Yes No
Will this cat be inside or outside?	Select One Inside Outside Both
If you go away for a few days, or on a vacation, who will take care of the cat?
If you move, will you take the cat with you?	Select One Yes No
How much are you willing to spend on medical bills for your dog?
What would you do if the vet bills go over this amount?
What provisions will you make for the cat should you become unable to care for it?
Are you willing to take responsibility for this cat for the next 10 to 15 years??
Have you ever applied to adopt an animal from S.T.O.P. in the past?	Select One Yes No
Are you willing to allow a STOP representative to come to see where the dog will be living?	Select One Yes No