First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

With regard to your current or previous cats, please answer the following questions:

ADDITIONAL ADOPTER'S INFORMATION

If you are adopting with a co-adopter (spouse, partner, etc.), what is their full name, email address and contact number? They will be equal adopters with you. If you are adopting on your own, please type N/A where indicated. *

What age group best describes you? (Valid current photo identification will be required to complete the adoption.)

How did you learn about us? Select all that apply, if multiple sources.

What is the name of the person who referred you to us? Please type N/A if not applicable.

What best describes primary pet caregiver?

Employment Information - Please provide information requested, which will only be used in an emergency.

What is your employment status? Employed full-time, Employed part-time Homemaker, Retired, Self-Employed, Student, Work from home.

If you are employed or self-employed, please answer the following questions. If you are not working, Please type N/A. Where do you work or what is the name of your company? What is the phone number where you work? How long have you been employed? *

If your spouse/partner is employed, please include the name of the company and the telephone number and how long he/she is employed at the company. Please include self-employment. If not, type status (retired, not working, student, etc.)*

CAREGIVER QUALITIES - Your responses help us find the perfect feline.

Is anyone in your household allergic to cats and if so, how are allergies handled?*

Gift Adoptions are only permitted from a parent to their child. This is because adopting a pet is an extremely personal decision and a non-transferrable obligation. If it is for your child or children, please list their names and ages.*

Please tell us in your words why you want to adopt?*

If for some reason you are unable to care for the cat(s) you adopt from us, do you have someone who is designated to take the cat(s) and continue to provide a safe home for them? What is their name, relationship to you and what is their phone number?*

CCI’s adoption policy states that if the adoption does not work out for some reason, you agree to give us the right of first offer and in good faith, to return the cat to us. Will you comply?*

Do you agree to participate in home visits prior or after adoption, and/or follow-up calls from CCI volunteers/representatives? *
Choose one: Yes No

Are you able to do Skype or Facetime? (If you live in an area where we don't have someone who can do a home visit, this is an alternative.)

RESIDENTIAL QUESTIONS - we check home ownership and rental agreements. The adopter's name(s) must be on the lease and we will require proof of paid pet deposit.

In what type of home do you live? Please select one.

Do you rent or own your residence? *

If you rent, have you paid your pet deposit? Your management company/landlord will be contacted for confirmation that you have paid it or that no pet deposit is required. Not providing this information will delay or cancel your screening form.*

Landlord's Name & Phone Number: if you own your home please put your phone number. If your relative owns the residence, please list their name and phone number. If you rent an apartment, please include the name of the apartment complex where you live. We do check the management company to confirm ownership or that the pet deposit has been been paid and that you can have pets. If you list yourself as the owner but your name isn't on the property appraiser's website as the owner, this could be a reason to decline your application.*

What are the names, ages and relationship of all the people living in your household? If they are roommates, are they on the lease agreement if you rent?*

WHICH CAT IS FOR YOU? 

How many hours per day will the cat(s) be alone without human companionship? Please choose the response that best fit your living situation.

Are you interested in kittens, teens, adult cats? Is the cat a for companion for another cat, dog only (no other cats live in household.) All of our kittens must be adopted into a home with another companion kitten or cat friendly dog unless otherwise specified. Please mark all that apply. PLEASE NOTE: BONDED PAIRS WILL NOT BE SEPARATED. Their names are joined on their web page.*

Which cat is your first choice to adopt? Cats listed with two names are bonded and will not be separated.
Choose an animal: Amber 3.6.19 Andy 9.18.19 Asher & Owen 9.5.19 (must be adopted with Owen & Asher 9.5.19 and Owen & Asher 9.5.19) Copper 1.25.25 Hansel 3.16.25 Kaleigh 3.15.25 Katy Purry 2.11.24 Kinsley 3.15.25 Leonardo DiCatprio 2.4.25 Levi 10.8.15 Mabel 1.25.25 Maple 1.25.25 Maria 7.15.24 Marmaduke 3.15.25 Mugsy 3.15.25 Owen & Asher 9.5.19 (must be adopted with Asher & Owen 9.5.19 and Asher & Owen 9.5.19) Penny 4.15.19 Pigeon 1.16.25 Shenan 1.15.15 Spanky 3.15.25 Spicey 2.1.20 Sunshine 9.21.09 Sweetie 2.1.20 Theo 5.14.24 Tiffa 8.15.22

Which cat would be your second choice? Cats listed with two names are bonded and will not be separated.
Choose an animal: Amber 3.6.19 Andy 9.18.19 Asher & Owen 9.5.19 (must be adopted with Owen & Asher 9.5.19 and Owen & Asher 9.5.19) Copper 1.25.25 Hansel 3.16.25 Kaleigh 3.15.25 Katy Purry 2.11.24 Kinsley 3.15.25 Leonardo DiCatprio 2.4.25 Levi 10.8.15 Mabel 1.25.25 Maple 1.25.25 Maria 7.15.24 Marmaduke 3.15.25 Mugsy 3.15.25 Owen & Asher 9.5.19 (must be adopted with Asher & Owen 9.5.19 and Asher & Owen 9.5.19) Penny 4.15.19 Pigeon 1.16.25 Shenan 1.15.15 Spanky 3.15.25 Spicey 2.1.20 Sunshine 9.21.09 Sweetie 2.1.20 Theo 5.14.24 Tiffa 8.15.22

If you have another cat or cats you are interested in, please list here. Keep in mind that cats that are listed with another cat are considered bonded and will not be separated.

Select which qualities you look for in a cat. Check all that apply.

If you are willing to adopt a special needs kitty, explain the type of disability you are comfortable with (i.e. vision-impaired or blind, deaf,diabetic, epileptic, feline leukemia positive, amputee, to name a few disabilities.). Otherwise put N/A*

Where will your adopted cat(s) live?

Are you planning to declaw the cat/kitten you are adopting from us?*

Would you like more information on declawing? *

CURRENT CATS, IF APPLICABLE (if you do not currently have cats, mark N/A where indicated.)

If you currently have cats, please provide the following information about each cat: Name, age, and sex. Have they been spayed/neutered? If not fixed, why not? Are all your cats current on vaccines? Have they been tested for feline leukemia and aids (combo tested)? Have they been declawed? Please list this information for each cat. If you do not have cats, please reply with n/a.

Where do your cats spend their time? (Please select all that apply.)
Choose all that apply: Inside my home only Inside my home but allowed to go outside Outside only; not allowed inside my home Inside my home and allowed on the screened in patio or lanai Inside my home and allowed on the screened in pool deck

Declawing - please select the response that best describes you.*

Previous Cats

Have you ever owned cats in the past?

If you used to have cats, what happened to them? If you have given up the cat, please give the reason. (If the question is not applicable, please type N/A.)

If you no longer have your cat(s), where did they live? Please use dropdown menu to select your response.*

Was your previous cat spayed/neutered? *

Mark which status applies to your previous cats. Please mark all that are applicable from the dropdown menu.*
Choose one: Came to me declawed already I declawed as an adult I declawed as kitten Not declawed

OTHER PETS

If you do have a dog(s), please list their name, age, breed, and if it has been spayed/neutered, or scheduled for the procedure. In one word, please describe your dog(s) personality and whether or not it/they have been around cats before. If it/they are a mixed breed, please list the known breeds. If you do not have a dog, please type n/a.*

Please list anything else we should know about your personal dogs and cats so that we may best fit the right cat to your home environment. Also, if you have any other pets not yet mentioned (reptiles, birds, etc.), please list here.

Are all of your other pets spayed/neutered if applicable? Please describe circumstances, whether medical, age-related or other reason, if applicable.*
Choose one: Yes No N/A

Have you ever given up a pet? If yes, please explain the circumstances.*

Please provide all the names of the vet(s), clinic(s) and number for each of your current or previously owned pets, even if you relocated from another city/state. If you never had a vet before, please type n/a. We will confirm the information you have provided regarding your cat(s) medical history, i.e. spay/neuter, combo test, vaccines, as well as information regarding your dog(s) and other pets. *

MISCELLANEOUS

A healthy cat will cost about $800-$,1000 a year and this amount changes as the cat gets older. Are you prepared for the costs of buying food, litter, yearly vaccinations, medical care, grooming, etc.? *

Most shelter/rescue animals have unknown medical backgrounds. Once you take possession of this animal, are you prepared to take the animal to a licensed veterinarian for regular check ups and any other necessary medical treatment at your expense?*
Choose one: Yes No

Please add my email address on CCI's mailing list to receive newsletters or information pertaining to CCI. I will notify CCI of any changes to my address, phone number or email address for them to update the database. CCI will not give my information to any other organization without my permission, except as permitted.*

Do you have any comments for us?

CERTIFICATION

I will notify CCI of any changes to my address, phone number or email address for them to update the database. CCI will not give my information to any other organization without my permission, except as permitted. 

By electronic signature, I hereby authorize CCI to contact the various agencies and veterinarian offices to confirm the responses I provided herein and for them to provide to CCI any information pertaining to my residence or pets I had in the past or currently still have in my care, whether they are my personal pets or those that I am caring for someone else.  Most rental agents and veterinarian offices require this screening form before providing information and will be provided upon request.

This Screening Form ("Form") is a multi-page document which will be incorporated into and made part of the Adoption Contract ("Contract"). CCI permits cats to go home the same day of the adoption but relies on the truthfulness of the answers provided. CCI will conduct an investigation of the facts relied upon on this Form. Falsification of any information on this Form will void the Contract and CCI will arrange for the return of the cat to CCI. CCI may refuse an adoption for any reason without having to state the reason, or may confiscate the cat(s) at any time, if the information given here is deemed incorrect or if the animal is not being cared for properly.  I understand that the adoption fee will be forfeited.  

CCI may arrange to pick up a CCI cat at any time, if the information given here is deemed incorrect, if the animal is not being cared for properly or you are in breach of the Adoption Contract. CCI will use all legal remedies available to them to facilitate this return. If legal fees and costs are incurred, you may be responsible for those fees. This Screening Form is the property of CCI and will not be returned to you and no copy will be given to you. 

I hereby confirm that the information supplied here is truthful. I am entering my full name and today's date as my electronic signature. *