First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email

Which animal are you interested in?*
Choose an animal: Ace Amora Arnold Arya - *FH -Training Camp Grad Aslan Bender FH Blueberry Pie Bober Casper *FH bonded with Mack (must be adopted with Mack *FH bonded with Casper and Mack *FH bonded with Casper) Catniss *FH* Cheez-it Cherry Pie Chunky Commander Cricket Dragon Duke FKA Thunder Eggs Elizabeth Ellie Ethel *BONDED* with Lucy FH (must be adopted with Lucy *BONDED* with Ethel FH) Frank FH Frankie FH General FH Gnocchi Jackson Jasper FH Journey Kiwi FH - Aloft Hotel Koda - Training Camp Kylo FH Luciano Pavarotti FH Lucy *BONDED* with Ethel FH (must be adopted with Ethel *BONDED* with Lucy FH) Mack *FH bonded with Casper (must be adopted with Casper *FH bonded with Mack and Casper *FH bonded with Mack) Major Mopar Morena FH Nacho Odin Panda Pepper FH Princess Pumpkin Pie Ritz Rosie Saltine Saraphina Sasha Smudge Spanky Stella FH Stymie FH Taco Tip FH Tower

What traits are you looking for in a cat?

How long have you been considering adopting a pet and why?*

If something were to happen to you or you are no longer able to care for your pet, do you understand that the pet MUST be returned to PRBJ?*

Place of Employment (if you are a student please list the school you attend)*

Employment Phone Number:

Are you 21 years of age or older?*
Choose one: Yes No N/A

Age*

How many consecutive hours will the pet spend alone during the day?*
Choose one: none 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Where will the pet be kept when you are not home?

Where will the animal be kept when you are home?

Where will the pet sleep at night?

What pets do you currently have? Please include their name, breed, gender, age, size and temperment. *

If you currently have pets, where are they kept?

Will THIS cat be indoor, outdoor or both?*

If you have cats or dogs, are they spayed or neutered? If no, please explain.*

Are your current pets up to date on their shots and flea preventative?

Have your current cats been tested for for feline aids and leukemia? If yes, did they test positive or negative? If not tested, why?*

If you currently have dogs or cats, do you use flea and tick prevention? If yes, what type and brand?

If you currently have cats, are they declawed? If yes, why and when did you have them declawed?

Are you planning to declaw this cat?*
Choose one: Yes No N/A

Have you ever owned a pet and, if so, how long ago?*

Have you ever had a serious behavior problem with a pet? If yes, please explain.*

If you adopt a cat and it develops undesirable behavior (hiding, not housetrained, spraying, etc), what will you do?*

Have you ever given up a pet? If yes, please explain the circumstances.*

What is the name of your current Veterinarian?*

What is the phone number for your vet? If you use more than one vet, please list all phone numbers.*

For verification purposes, who is listed as the owner of the pets on the vet records?*

Including yourself, how many people (PLEASE LIST FIRST AND LAST NAMES, GENDER, AND AGE) reside in your household? (Your application cannot be processed without a complete answer to this question)*

Are you expecting a child or planning a family in the near future?*

Do you have children living with or frequently visiting you? If yes, what ages?*

Who in the household will care for the pet?*

Do any members of your family have allergies? If yes, what type?*

Are all members of your family in favor of adopting this pet? If not, please explain. *

In what type of home do you live?*
Choose one: Apartment Duplex Military Housing Mobile Home Single Family Townhome/Condo

Do you own or rent your home? (We do verify this information.):*
Choose one: Rent Own

If no, list name of landlord/property manager and phone number. *We do call to verify.

Do you have approval from your landlord or rental company to have an animal? PERMISSION NEEDED FROM LANDLORD! (If you own, please select n/a)
Choose one: Yes No N/A

List at least one reference (who is not a family member). Include name and phone number.*

How did you hear about Pet Rescue By Judy?

Comments / Is there anything else you want us to know?*

APPLICATION CERTIFICATION: I understand that Pet Rescue By Judy (PRBJ) obtains pets that are strays or from a third party and therefore all information regarding its age, breed, health status and/or temperament is estimated and is not warranted or guaranteed by Pet Rescue By Judy. If I adopt a pet from PRBJ I agree to keep it as an indoor pet, treat it humanely and provide for its medical needs. I will not allow the pet to roam free/become a nuisance or to be used for experimental purposes. I will not sell, give away, destroy or otherwise dispose of the pet without notifying and obtaining permission from PRBJ. I understand that the stated minimum adoption donation is not a reflection of the direct costs incurred by PRBJ for this specific pet and will be applied to the overall general costs of operating a no-kill animal rescue. If I adopt a pet from Pet Rescue By Judy, I agree to keep my contact information current on the PRBJ website so that I may be contacted should my pet become lost and returned to PRBJ. I certify that the information entered on this application is truthful and I have not tried to mislead PRBJ in any manner by my answers. (Name and Date)*