Page 1 of 2 Adopt App 7-20-15
P.O. BOX 3795
WALNUT CREEK, CA
94598
ADOPTION APPLICATION FORM
COMMUNITY CONCERN FOR CATS
IN ORDER TO BE CONSIDERED FOR AN ADOPTION TODAY YOU MUST:
*BE AT LEAST 21 YEARS OLD *HAVE A VALID CA IDENTIFICATION
*VERIFY THAT YOU ARE ALLOWED PETS WHERE YOU LIVE
PERSONAL INFORMATION (PLEASE PRINT CLEARLY AND ANSWER ALL QUESTIONS)
Have you ever adopted from CC4C in the past? YES NO If yes, when:
Are you 21 years of age or older? YES NO
Do you have valid California identification with your name and current address? YES NO
Applicant’s Name:
Cell phone:
Co-Applicant’s Name:
Cell phone:
Address: Apt: Home phone:
City: Zip Code:
Email: Email:
Are you: Working Retired Attending school Working at home Other:
Applicant’s Employer: Work phone:
Co-Applicant’s Employer: Work phone:
Is the above address a: House Townhouse/Condo Mobile Home Apartment
How long at the above address? ______ Years ______ Months
Do you: Rent Own
If renting, list name of Complex:
Name of Landlord: Phone:
Are you planning to move within the next six months? YES NO
How many in household: Adults ( ____F /____M) Children
____F /____M
Ages of children:
Do all members of your household agree to a new pet? YES NO
Does any member of your household have allergies to cats? YES NO
I travel: Frequently Occasionally Almost never
References: Please list two references not living with you, including phone numbers, below:
CAT PREFERENCES
I am choosing this pet for someone outside my household: YES NO
If YES, comment:
I like cats that have: Short hair Medium hair Long hair All
I prefer a: Male cat Female cat No preference Why?
Please describe the temperament and activity level you are looking for in a cat: (check all that apply)
Zippy, high energy, kitten like Talkative Responsive Lap cat
Mellow, easy going Quiet Independent Very affectionate
Someone in my home is nervous around or unsure of cats: YES NO No Experience
The noise/activity level at my home is usually: Low Medium High
I need a cat that will tolerate being alone at least: Hours per day
What will you do if your cat develops behavior issues such as scratching, meowing too much, biting, clawing furniture,
shedding or urinating inappropriately?
