| First Name: |
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| Last Name: |
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| Street Address: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Phone Number: |
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| Email: |
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| Your occupation: |
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| Your age: |
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| Do you rent or own? |
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| Ages of other members in your home: |
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| How did you hear about CAPS? |
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| Have you owned a pet before? |
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| Name of cat you wish to adopt: |
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| Why do you want to adopt a cat? |
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| Who would be the primary caregiver? |
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| Who would care for the cat if your family went on vacation? |
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| Where will the cat be kept during the day? |
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| Are there any other pets living in the home? |
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| If so, list number of pets and type of pets: |
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| If you have other pets, are they spayed/neutered? |
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| Which pets do you no longer own and why? |
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| Under what circumstances would you give up a cat? |
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| List the most important responsibilities in owning a cat: |
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| Please provide a pet history of the last 10 years (gender, age, spay/neuter, where they are now) |
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| If you have a pet, please provide the vet's name, address, and phone number: |
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| List the names and phone numbers of 2 references unrelated to you: |
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