Adoption Agreement Form


Thank you for completing this application and contract. The information that you
provide will help ensure a successful adoption.
Today’s date ______________ Adoption date (ASAP to complete) _________________
Cat #1 ________________________ KC# __________________ Intake date _________
Cat #2 ________________________ KC# __________________ Intake date _________
Name: ____________________________ Spouse or partner’s name: _____________________
Current address (incl. street/unit/city/zip): ___________________________________________________________
Students, please provide home address: _____________________________________________________________
Phone (primary): ________________ Phone (other):_______________ E-mail: _____________________________
You are: q  employed full-time q  employed part-time q  retired q  student q  other: _________________
Number of hours an adult is usually at home: q  all day q  out part-time q  away 7 or more hours per day
Driver’s license #: ___________________  State: _____  Expires (mm/dd/yy): _________  Volunteer initials: _____
When you have completed this form, please present your license to your ASAP adoption counselor.
Do you own your residence?
q  Yes
q  No
If you do not own your residence, please provide the full name and phone number for the owner/landlord:
Name on title of residence (if known): ______________________________________________________________
How long at current residence? ____________________ Do you plan to move in the coming year? q  Yes q  No
Number of adults in household: _______   Number and ages of any children in household: ____________________
Full names and phone numbers for all adult co-tenants/housemates: ______________________________________
Note: All adult co-tenants/housemates must consent to the adoption.
Do you have consent from all adult household members to adopt a cat(s) or kitten(s)? q  Yes q  No
Household activity is usually: q  low q  medium q  high
Have you had a cat(s) in the past 5 years? q  Yes q  No
If yes, do you still have the cat(s)? q  Yes q  No
If no, what happened to the cat(s)? _________________________________________________________________
List cats in household (include sex, age, and if spayed/neutered): _________________________________________
List dogs in household (include breed, sex, age, and if spayed/neutered): ___________________________________
Has/have the dog(s) lived peacefully with cats?
q  Yes q  No
List any other pets: _____________________________________________________________________________
What type of cat are you looking for? q  indoor only q  indoor/outdoor q  other: _______________________
Name of local veterinarian: ________________________________ Can ASAP call for reference? q  Yes q  No
Would you like to receive coupons or promotional material from Hills/Science Diet? q  Yes
q  No
How did you hear about ASAP? ___________________________________________________________________
To ensure the safety of the cat(s), ASAP reserves the right to conduct a property inspection when applicable. A cat
or kitten is not to be given as a gift. The person completing this adoption application and the following contract is
to be the caregiver of the adopted cat(s) at the address stated above.
rev. 11/2014
(complete other side with adoption counselor)


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