UN CHATOU Registered Charity Organisation

Adoption request form

PS: do not highlight the answers in yellow please

Name of the cat prior to adoption____________________________________ Date ________________

First and last name of the adoptant __________________________________ Profession ____________

Address __________________________________ City_____________________ Postal Code _______

Email ________________________________ Cellphone __________________ Other______________

Are you a student ? Yes ___ No___ Where you live, are you allowed to have a cat? Yes____No ____

Which floor do you live on _______? Number of rooms in your dwelling ?______ Is there any smokers in

the house? yes ___ No ___ Are you planning on changing in the next month or two (Tick): Schedule ___

Hollidays ____ Moving ____ How many members have you in the house? ___________

First and Last Name Âge

________________________________________ _____________

________________________________________ _____________

________________________________________ _____________

________________________________________ _____________

Do they all agree to adopt the cat? Yes ___ No ___ When would you be ready to adopt the cat? _______

If you are currently in a relationship, what will happen to the cat(s) in case of separation ? ____________

____________________________________________________________________________________
In the futur, if you are in a relation, what will happen if the new partner doesn’t want the cat? __________

____________________________________________________________________________________
Do you have a cat? Yes ___ No___ Sterilized? Yes __ No__ Have you ever owned a cat ? Yes __ No
___

What happened to him _________________________________________________________________

Was he/she an indoor cat? ___ outdoor cat?___ Do you have a dog? Yes ___ No ___ Sterilized: Yes___

No ___ Do you have any other pet/animal? ____________________________ Sterilized? Yes ___ No__

If you do own other animals in the house, how do they behave towards cats in general?

Gentle _____ Playful ____ Calm ____ Nervous ____ Scared ____Very active ____ Agressif ____

Why do you want to adopt this cat?________________________________________________________

A cat can live up to 20 years. Are you willing to make a lifelong commitment ?Yes ____ No ____
Are you willing to work on behavioral issues Yes ____ No ___ on socialization issues? Yes ____ No ____

If you ever have problems (medical or behavioral) with the cat, what will you do? ___________________
____________________________________________________________________________________

What kind of problem you are NOT willing to work on ? ________________________________________

____________________________________________________________________________________

What reasons would make you surrender your cat ? __________________________________________

____________________________________________________________________________________

What would you do if you couldn’t keep you cat(s) ? __________________________________________

____________________________________________________________________________________
Have you ever had to surrender a pet ? Yes ____ No ____ If “Yes”, what were the circumstances?

____________________________________________________________________________________
Informations on the profil you are looking for:

Sexe: Male ____ Female ____ Hair: Short ____ Medium ____ Long ____ Age: Kitten ____ Adult __

Senior ____ Claws: Declawed ____ Not declawed ____ Energy level: Low ____ Average ___ High ____
I would like my cat to: Very important Important Not important

Be friendly with children

now and in the futur
Be friendly with other cats

Be friendly with dog

Be friendly with me

Be friendly with visitors

Like to be brushed

like to be held in my arms

like to be petted

be playful

be calm

be independant

never wake me up at night

never be agressive

Always go to its litterbox

Number of hours the cat will be alone everyday? ________ Number of hours dedicated to the cat

everyday? ______ Who will take care of the cat? ____________________________________________

Will the cat(s) be roaming freely while you are away? During the day? Yes ___ No ___

During the night? Yes ___ No __ If no, where will he be? ______________________________________

Will the cat be kept inside yearlong now and in the futur (in the city and in the country)? Yes ___ No ___

Do you have screen on the windows? Yes ___ No ___ If not, do you have air conditioner? Yes ___ No __

Do you intend to declaw the cat? Yes ____ No _____

Are you or any of your family members allergic to cats ? Yes____ No ____ What would you do if a family

member were to develop an allergy to cats ?________________________________________________

What are you willing to do to accommodate the needs of the cat? (her/his need to scratch, to exercise, to
play, to avoid other animal company, to look outside by the windows, ...) ?
____________________________________________________________________________________

What would you do if you have to travel for a couple days or more ?______________________________

Are you aware that having a cat may cost more than 1 000$ per year ? Yes ____ No ____

A cat may also need unexpected cares such as surgery, medications, accident which may occur major

additional costs? Would you be able to afford that kind of expenses? Yes: ___ No: ___ Do you plan to

have a medical insurance for your cat? Yes: ___ No: ___ Do you have a veterinarian? Yes: ___ No: ___

If yes what are his /her name, address? ____________________________________________________

In case you move away, what would you do with the cat(s) ?____________________________________

In order to have an idea where the cat is going to live, will you let us come and visit your place ? Yes __ No __

Can you give us some reference (family, longtime friends)

First and Last name Phone number Relation

____________________________ ____________________ ________________________

____________________________ ____________________ ________________________

I confirm that the above information is real and accurate. I understand that completing this form
does not guarantee that I will be the one who will adopt the cat.
An adoption contract will be sent to you if you are approved by “ Unchatou‘’

We ask for adoption donation/fee of 350$ to recuperate some of the veterinary fees (sterilization,
first basic vaccine, microchip and dewormers, treatment again flees or hear mites).

I understand that the adoption of a pet is a lifelong commitment and should be a well thought out
decision
 Signature (electronic accepted) of the adoption applicant : Date :

Return the application form to : Dominique Mertens unchatou2@gmail.com