Cat Application Step 1 of 4 0% Please review the BARC cat adoption policies here.Date:* MM slash DD slash YYYY Age of cat desired:Please enter a number from 0 to 20.Name of cat desired, if known: Youngest cat considered:Please enter a number from 0 to 20.Oldest cat considered:Please enter a number from 0 to 20.Applicant InformationName:* First Last Suffix Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone Numbers:HomeWorkCell Email:* Enter Email Confirm Email Number of People in Household:If children are in the household, please list ages (separate by commas): Are you or any member of your family allergic to pets? Yes No Are you presently: Employed Unemployed Retired Student Employer: General InformationType of residence: House Apartment Townhome Condo Mobile Home Farm Do you own or rent? Own Rent If rental, are cats allowed? Yes No Maybe Complex Name: Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Manager/Landlord: First Last Phone Number:Type of street: Very busy road Moderate traffic Slight traffic Speed limit: Where will cat live? Inside Only Outside Only Both If both, what percentage?Inside (%)Outside (%) Where will the cat spend nights? Family Member's Bed Cat Bed Garage Outside Other Do you have a cat door? Yes No How many hours a day will the cat be alone?Please enter a number from 0 to 24.Where will the cat stay while the family is away from home (including short errands)? Describe the activity level in your home: Busy (visits by friends, meetings, children, parties at home) Noisy (Stereo/TV, tools, children playing, dogs barking) Moderate (Normal comings and goings) Quiet (homebodies, few guests) Other If other, please specify: Under what circumstance would you return the cat?In the absence of the primary caregiver, who will care for the cat? This may include going on vacations, being in the hospital, etc.Would you mind if a representative of BARC came to your home to visit? Yes No Are you willing to take responsibility if this cat acquires an illness? Yes No Have you ever declawed a cat? Yes No Do you plan to declaw this cat? Yes No A cat can live 15-20 years. Are you financially ready and willing to provide the medical care your cat will need for its lifetime? Yes No If something happened to you, who would care for the cat? Pet InformationDo you have animals now? Yes No If yes, please list them below:Name, Breed, Male or Female, Age, Spayed/NeuteredIf any of your pets are not spayed/neutered, please explain why not:Are they current on vaccinations? Yes No Not Applicable Have you had pets in the last five years? Yes No If yes, please provide details for each pet below:Name of Pet, Breed, Age of dog, Years Owned, Spayed/Neutered, Inside/Outside, Please list approximate % of time inside and outside, Where is Pet Now? Current or Past Vet (Name of Clinic): Current or Past Vet (Phone Number):Are there any behavioral issues or special needs with any of your current pets? Yes No If yes, please explain the behavioral issues or special needs:Have you ever had to surrender or re-home an animal? Yes No If yes, please explain:Where was the pet surrendered to? Are you applying to adopt a pet from another rescue? Yes No If yes, from which center? Have you ever adopted a rescue animal? Yes No If yes, provide details:Group's name:Animal's name: Personal Reference (NOT RELATED)Name: First Last Relationship: Phone Number:Best time to contact: Comments:Please provide any other information you may want to include in regard to adopting this pet. PLEASE NOTE THAT IT MAY TAKE UP TO A WEEK TO PROCESS YOUR APPLICATION. If it appears you would be a good match for the dog you are applying or if we need any clarification, we will contact you after reviewing your application. The application must be complete with all questions answered in order to be processed. We reserve the right to disqualify any applicant if any of the above information is not accurate. Thank you for applying for a BARC rescue dog.Signature*By signing this, I acknowledge that I have filled out all of the above information truthfully on this date.
