Cat Adoption Application

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Animal Name/ID Number

Name

First

Last

Current Street Address

City

State

Zip Code

Date of Birth

Drivers License # and State Issued

Primary Phone

List all Family members in household (with ages)

List all pets in household ie,dog,cat or other include male or female and if the animal is spay/neutered Are they up to date on all vaccines? Answer for each pet.

Do you own or rent your home?

If rent give landlords name and contact information

What Veterinary hospital that will be used for your new pet?

Please read through and type your initials next to each of the following statement,

I understand that Southern Tier Animal Control Inc. makes no representations whatsoever relating to the health, habits or any other fact about the cat.

I understand that my pet may have an illness that is not immediately apparent and Southern Tier Animal Control Inc, is not responsible for veterinary care should the dog have an illness.

I understand that there is a risk that my current family pet could b exposed to illness and Southern Tier Animal Control Inc. is not responsible for their veterinary care should they become ill.

I understand that it is recommended that my new pet be isolated from my current family pets until it has seen my veterinarian.

I agree to call within 5 days of the adoption to make an appointment to take my new pet to my veterinarian (wellness check and schedule spay/neuter appointment)

I understand that a pet needs to be seen by a veterinarian at least once a year for an animal physical, vaccinations and flea/heartworm preventatives.

When you sign you are signing to notify STAC if you have rehomed/or the cat is no longer in your care. You will furnish the information of where the cat is and information that allows STAC to contact the new owners.

I understand that New York State Law requires wriiten permission before releasing my new animal's medcal information to anyone but me. By initialing this form ans signing the agreement below, I am allowing Southern Tier Animal Control Inc. to ontain all information concerning my animals from the veterinary hospital that i have provided on this application.

By typing your name below you are signing this document, I am accepting all of the risks associated with the handling of animal suring the adoption process. I understand that this document will be retained on file by Southern Tier Animal Control Inc. I further attest that the inofrmation I have given is true and understand that giving any false or incomplete information may resut in the application being denied.

Stop application here SHELTER INFO ONLY Date Reviewed

Approved

Denied

Kennel Manager Signature and Date