Doodlebug Manor 501C3

Doodlebug Manor 501c3 Adoption Application

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When you adopt a rescue/shelter pet you help to save two lives: the one you bring home and the one who takes its place. ______

Part I: Contact Information

Applicant Name: (First Middle Last) ______

Address:______County______

City: ______State:______Zip: ______

Phone(s): Home______Wok/Cell ______

Email Address: ______Place of Employment: ______Are you at least 18 years of age Y N Driver’s License State and # ______

Ages of all family members living in the household ______Does anyone living in your household have pet allergies? Y N

Do you… Own Rent If you Rent: *Landlord's name/phone______Do you have the permission of landlord to have a cat? Y N

Part II: Cat/Kitten Information

Is there a specific kitten/cat you’re interested in? ______What is your interest in adopting a cat? ______Have you owned a cat before? Y N

Are you adopting for yourself or someone else? ______

What are the main traits you’re looking for in your new pet? ______

Do you currently have pets? Y N Have you in the past 5 years? Y N

Please list Breed, Age, Sex and current status of each pet: ______Were your current (& past) pets: Spayed/neutered? Y N Where will the pet primarily stay? Indoors Outdoors Both

Current on vetting? Y N When you are away from the house? ______Declawed? Y N If you move, what would you do with the pet? ______Do you plan to declaw? Y N

6/2011 Part III: Care and Maintenance

Name of Current Veterinarian or Vet You Intend to Use: ______Vet’s Phone Number: _____ Clinic Location:______Last name on the Vets’ record ______Pet Name:______

Are you prepared to take on financial responsibility for this cat upon adoption? Y N

Are you willing to provide routine vaccines & veterinarian care for this pet? Y N

Are you prepared for common cat behavior problems, such as clawing or litterbox accidents? Y N Please list what you are not prepared to deal with: ______

Have you sold, given away, or surrendered a pet to a shelter? Y N

If yes, please specify ______

Have you, or any member of your family/household been cited for cruelty to animals in the past? Y N

If yes, please specify ______

Comments: Please provide any additional information you feel is important:

I/we attest that the information provided on this application is true and accurate to the best of my/our knowledge and acknowledge that any false information will null and void any application or contract of adoption.

This application does not guarantee that the adoption is guaranteed, you must meet Doodlebug Manor qualifications to complete the adoption. You recognize the right of Doodlebug Manor to turn down any application for any reason. Any false information will null and void any application or contract of adoption. My signature below is my testament to agreement to these terms.

Applicant's Signature ______Date ______

2 Doodlebug Manor P.O. Box 100644, Nashville, TN 37224 Email: [email protected] Voicemail: 615 501-7342

3 Doodlebug Manor P.O. Box 100644, Nashville, TN 37224 Email: [email protected] Voicemail: 615 501-7342