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.  ___________________________________________