Little Buddies Adoption and Humane Society

P.O. Box 1543   Centreville, VA   20122-1543

littlebuddies@erols.com     (703) 264-0387

 


Application For Adoption of a Cat or Kitten


 

This form is to help Little Buddies determine the best match between the animals awaiting adoption and their prospective adopters.

 

Adopting a cat/kitten requires a significant commitment, daily food and water, a clean litter box, plus veterinary care when needed.  If you are not prepared to provide this, you should probably not adopt a companion animal.

 

 


Your Household

 

Name(s) and ages of each household adult over age 18 _____________________________________

 _________________________________________________________________________________

 

Occupation(s) of household adults  _____________________________________________________

 

Are there any children under age 18 in the household?     Yes 5         No 5

List the ages of all children under age 18 in the household:  _________________________________

 

Have the children had animals before?  Yes 5     No 5     Was this successful?  Yes 5     No 5

If not, please explain.  _________________________________________________________________________________

 

Has anyone in your household ever been convicted of a violent crime?  Yes 5     No 5 

If yes, please explain.  _______________________________________________________________

 

Are there any problems with abuse of adults, children or animals in your household?  Yes 5  No 5 

If yes, please explain.  _______________________________________________________________

 

Has anyone in your household ever been convicted of the abuse or neglect of any animal? 

Yes 5        No 5       If yes, please explain.  ___________________________________________

                                                                             


 

Please list three personal references and their relationship to you:

 


         Name

Relationship

Phone

Address

 

 

 

 

 

 

 

 

 

 

 

 

Your Home

 

Address______________________________________________________   Apt. #  ____________

City     _______________________     State   ________________________     Zip   _____________

 

Home phone  _____________________     Work Phone   _________________________________

E-mail address  _______________________________________  FAX   _____________________

 

Do you own or rent your home?  _____________________________________________________

Is your home a:    5 single home,         5 apartment           5 duplex          5 townhouse         

                    5 mobile home        5 other  _____________________      

 

Are there any community restrictions to cats?   Yes 5          No 5

    If yes, please explain.   ___________________________________________________________

 

If you rent, do you have written permission from your landlord to have a cat?   Yes 5        No 5

Landlord name   _______________________________  Landlord phone  ____________________

 

How long have you been at your present address?  _______________________________________

 

Are you planning to move within the next 6 months?       Yes 5        No 5

 

Will all of your companion animals go with you if you move?    Yes 5        No 5

 

Is anyone in your home allergic to cats?    Yes 5        No 5

  If yes, please explain.   _________________________________________________________

 

Does anyone in your home smoke cigarettes?  Yes 5        No 5

Is there any problem with drug or alcohol abuse in your home?  Yes 5        No 5  

 


Cats In Your Household:

How many cats are currently living in your household?  _________       Please list them here.

 

    Name

Age

Time In Your

Care

Goes Outside

Yes or No

Spayed/Neutered

Yes or No

Declawed

 Yes or No

 Wears ID

  Yes or No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

To your knowledge, have any of your cats tested positive for feline leukemia or feline AIDS (FIV)? 

Yes 5        No 5        If yes, please explain:  ___________________________________________

 

Do all of you cats get along with each other?  Yes 5        No 5      If no, please explain:  ______________

 

 

Dogs In Your Household:

 

How many dogs are currently living in your household?  ___________      Please list them here.

 

Name

Age

Breed/Mix

Time in

Your care

Neutered

Yes or No

Gets along with cats

Yes or No

Wears ID

Yes or No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do any of the dogs in your household have any behavioral or dominance problems?  Yes 5       No 5

If yes, please explain.  ________________________________________________________________

 

Do any of the dogs in your household have any behavioral problems?  Yes 5         No 5

 

If yes, please explain:  _______________________________________________________________

 

 


 

 

Other Animals In Your Household:

Do you have any animals other than dogs or cats?  Yes 5      No 5

If yes, what type and how many?  ________________________________________________________

 

 

 

 

 

 

Veterinary Care

 

Name of your veterinarian:     ______________________________________________________

Address  _______________________________________________________________________

Phone     _______________________________________________________________________

 

 

Do all of your companion animals receive yearly veterinary visits?  Yes 5        No 5

If no, please explain.  _____________________________________________________________

 

Do all of your companion animals receive vaccinations as required?  Yes 5       No 5

If no, please explain.______________________________________________________________


 

 

 

 

Previous Companion Animals:

 

Please list all companion animals whom you have had within the past 10 years whom have died.

 

Please list all companion animals whom you have had within the past 10 years whom are no longer with you for reasons other than death.

 

 


Name

Year and age of death

Cause of death

 

 

 

 

 

 

 

 

 

 

 

 

Name

Year and reason for separation

Current location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Cats Going Outside

 

There are many dangers inherent in letting cats go outside.  These include:

 

  1.  Being hit by a car

  2.  Poisoning by chemicals such as lawn chemicals, antifreeze, rat poisons, and others

  3.  Contracting diseases such as feline leukemia, feline Aids (FIV), and feline infectious peritonitis

       (FIP).

  4.  Abuse by humans—being shot, killed, or beaten

  5.  Getting lost

  6.  Being stolen (possibly being stolen for the purpose of selling to an animal experimentation lab)

  7.  Complaints from neighbors

  8.  Being killed by outdoor predators such as coyotes, wolves, etc.

  9.  Being injured or killed by dogs

 

I have carefully read and considered the risks as listed above.  Yes 5        No 5

 

I understand that Little Buddies does not allow cats adopted from Little Buddies to go outside.  They must be indoor-only cats.  I agree to abide by this.  Yes 5    No 5

 

 

 

 

 

 

Declawing Cats

 

Cats should never be declawed.  There are many important reasons for this.  These include:

 

  1.  Declawed cats tend to be more aggressive and display more biting behavior than cats who are not

       declawed.

  2.  Declawed cats are significantly more likely to urinate outside the litter box than cats who have not

       been declawed.  Urinating outside the litter box can destroy a home.

  3.  Declawed cats are in greater danger should they ever accidentally get outdoors because they cannot

       climb high places to escape predators and cannot defend themselves.

  4.  Declawed cats cannot climb high cat scratch posts or condos for exercise.

  5.  Declawing is illegal or considered inhumane in many countries including Australia, Austria, Eng-     

       land, Germany, Spain, and Sweden.

 

I have carefully read and considered this list of problems associated with declawing.  I AGREE NEVER TO DECLAW ANY CAT ADOPTED FROM LITTLE BUDDIES.  Yes 5    No 5

 

Financial Factors

 

Each companion animal will cost a household about $500.00 per year.  Are you financially able to provide this for each of the companion animals whom you currently have, as well as for the new animal you would like to adopt?      Yes 5          No 5

 

Are you financially able and willing to provide annual checkups, vaccinations and ANY medical care necessary for each of the companion animals whom you currently have, as well as for the new animal you would like to adopt?      Yes 5          No 5

 

I have been told what the adoption fee is for a cat or kitten adopted from Little Buddies.   I understand  that if the cat is not spay/neutered, Little Buddies will pay for a routine spay/neuter at the vet of our choice, but not for any other costs associated with the surgery such as blood work, pain medication, etc.  We do not pay for any vaccines that are still needed, nor for any other medical expenses after the cat arrives at your home.   Yes 5       No 5

 


Giving Your Cat A Good Home

 

Indoor cats can live to be 18-20 years old.  Can you commit to care for the cat you adopt for his/her entire life?    Yes 5   No 5

 

How long are you willing to allow the new cat to adjust to his/her new home?  ____________________

 

What will you do if your new cat does not get along with your present companion animals?  _________

___________________________________________________________________________________

 

How long are you willing to allow the new cat to adjust to other animals in the home?  _____________

 

If your cat gets lost, in addition to contacting Little Buddies, what steps will you take?  _____________

___________________________________________________________________________________

 

Who will care for your cat if you go away?  _______________________________________________

 

How will your new cat spend his/her days? (Circle everything that applies)

    Indoors    Outdoors    Basement    Garage    Porch    Yard    Barn    Locked in room    Crated

 

How will your new cat spend his/her nights?  (Circle everything that applies.)

    Indoors    Outdoors    Basement    Garage    Porch    Yard    Barn    Locked in room    Crated

Please describe the kind of cat that you are interested in adopting:

 

Age  _____________             Breed  ___________________________

Sex  _____________              Reason for sex preference  _____________________________________

Coloring  ___________          Temperament  _______________________________________________

 

Why do you want to adopt a cat?  ________________________________________________________

__________________________________________________________________________________


 

 


 

 


Acknowledgement

 

I/We acknowledge that all of the information provided in this application form is true and correct.  I/We understand that any misrepresentation of fact may result in Little Buddies refusing adoption privileges to me/us.  If my/our request is approved and later Little Buddies discovers that any of the information is not true or correct, Little Buddies reserves the right to remove the adopted cat from my/our home.

 

I also agree to allow Little Buddies to visit my/our home by appointment as part of our application process.

 

Signature of Applicant(s)  ________________________________________________________________

                                         _________________________________________________________________

 

Date of Application  _____________________________________________________________________

 

Little Buddies Staff Signature   ____________________________________________________________