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Adoption Application Form
Crystal Creek Rescue
>
Adoption Application Form
Adoption Form
Please fill out all required fields, submit the form, and we will be in touch!
Cat's Information
Cat's Name I Want To Adopt
*
Cat's Identification Number
Cat's Date Of Birth
Cat's Sex
Adoption Fee
*
Your Information
Name
*
First
Last
Phone
*
Email
*
Address
*
Street Address
Address Line 2
City
Select
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Age of all household members
*
List any animals you current own, their age, and whether they are spayed/neutered or not.
*
Are all of your animals current on vaccinations?
*
Yes
No
Some
Not sure
What is the name of your veterinarian?
*
What is the phone number of your veterinarian?
*
List the animals you previous owned in the last 2 years and where are they now?
*
Do you own or rent?
*
Own
Rent
Type of dwelling:
*
Please select
Apartment
House
Trailer
Condominium
If renting, please list landlord's name and phone number
Where will the pet be during the day?
*
Loose in house
Kennel or crate
Garage
How many hours will your pet be alone during a typical day?
*
Please enter a number less than or equal to
24
.
Why do you want to adopt this pet? As a companion for…
Me
Another person
Another pet
Do you plan to declaw your cat/kitten?
*
Yes
No
Do you plan to keep this cat/kitten inside or outside?
*
Inside
Outside
Please read and check each box below.
*
We ask for an adoption fee to help cover the costs of the cats/kittens veterinarian visits including spay/neuter services, medications & rabies, chipping, food and care. Some breeds are higher fees. These donations allow us to operate.
I understand that this application does NOT reserve this animal. I understand that the adoption agent has the right to deny or postpone any adoption. All information provided is true to the best of my knowledge.
Signature
*
Date
*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.
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