Pre-Adoption Form * Indicates required field Step 1 of 7 14% Name* First Last Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Preferred Contact MethodEmailPhoneNo PreferenceHave you adopted with us in the past?YesNoWhen (month/year) and the cat's name?How did you hear about Crash's Landing?Why do you want to adopt from Crash's Landing? HOMELIFEPlease list the names of all adults in the household and your relationship to them.Please list the ages of all children in the household.Roommates?YesNoDo all of the adults in the household know you plan to adopt a cat?YesNoHave your children lived with cats previously?YesNoN/AIs anyone in your household allergic to cats?YesNoHow do you plan to address the allergy?Household Activity LevelQuietActiveVery ActiveDo you rent or own your home?*OwnRentDo you have permission from your landlord to have a cat?YesNoLandlord's name and Phone Number* PET HISTORYHave you owned a cat before?YesNoDo you currently have pets?YesNoTell us about your pets (name, type, age, spayed/neutered, length of time in your family)List all pets you've had in the past 10 years and why you no longer have the pet.The cat will live:IndoorsOutdoorsIndoors and OutdoorsNot sureWhere will the cat be when nobody is home?IndoorsOutdoorsIndoors and OutdoorsCurrent veterinarian: name, clinic name, phone numberThis field is required if you currently have pets or if you have had any pets in the last 10 years.Under whose name and what address are records kept?Are your pets current on vaccines?YesNoHow often do you plan to take your cat to the veterinarian?How many litter boxes do you intend to have for your cat(s)?Please enter a number from 0 to 1000.Have you recently had a cat that did not use the litter box?YesNoWhat did you do about the issue with the litter box? NEW PETOn the first night home, where will the cat stay? (be specific)It may take a cat a month or longer, especially when other pets are involved, to adjust to its new home. How would you address this?Are you committed to providing a home for this cat for the next 10 to 20 years?YesNoWhat circumstances might justify giving up a cat? (check all that apply) Baby Moving Shedding Want to travel Divorce Allergies Behavior problems Cat becomes ill Children lost interest Cat not getting along with other pets Not using littter box Destructive Scratching Too time consuming None Other Other circumstance to give up a catIf your new cat exhibits behavioral or adjustment issues, how will you address this?What do you estimate will be the annual cost for caring for this pet?Please enter a number greater than or equal to 0.Are you willing to provide, and can you afford, emergency care for this pet?YesNoIf you go away for a few days, or on vacation, who will take care of the cat?What arrangements will you make for the care of your pets in case of emergency, or if you become unable to care for them?If you move, will you take the cat with you?YesNo REFERENCES *** Please enter three references other than family members.Reference 1Name* First Last Relationship*Email Phone*Best time to call*Reference 2Name* First Last Relationship*Email Phone*Best time to call*Reference 3Name First Last RelationshipEmail PhoneBest time to call YOUR IDEAL CATDeclawedYesNoPreferablyNo preferenceAgeBaby (less than 1 year)Young (1 to 2 years)Adult (3 to 7 years)Senior (more than 7 years)No preferenceCoat lengthShortMediumLongNo preferenceSpecial needsYesNoMaybeNo preferenceTemperament OUR CATSIf there are specific cats you wish to meet at Crash's or Big Sid's, please list them here. (You can, of course, visit with any of our cats.)SUBMITTING YOUR APPLICATIONBy clicking the Submit button below, I certify that: * The information I have given is accurate * I understand that Crash's Landing has the right to deny any application * I give permission for a representative of Crash's Landing to call the references and veterinary practice I have listed above