Last Name:	First Name:	

Meezer Pleasers Siamese Cat Rescue, Inc.
P.O. Box 351
Shrewsbury, PA 17361
717-235-3951
	P.O. Box 351
Shrewsbury, PA 17361
717-235-3951 (phone)
(215)754-4146 (fax)
meezerpleasers@aol.com 
http://meezerpleasers.petfinder.org                                       
Adoption Application	
Date: _________                                                         Date Approved:_____________

Personal Information	
First Name:
	Last Name:
	
Address:
	
City:
	State:
	Zip Code:
	
Do you live in a : House Townhouse Apartment Duplex Condo Mobile Home  (please circle one) 	Employer:	
Home Phone: (Include area code)  PLEASE INCLUDE THE BEST TIME TO REACH you                     610-488-1085 evenings or at work phone
	Work Phone: (Include area code)
	
Home E-mail:
	Work E-mail:
	May we phone you at work?   YES   NO	
Nearest Large City:
	Cell phone:(Include area code)	Pager: (Include area code)	
Vet Information:	
Vet’s Name:
	Phone:	
Address:  
	
City:   
	State:   
	Zip Code:
	
Family Information:	
Who will be affected by this adoption?  Significant Other?  Children?  

Adults living in household (please include number and ages)

Children Living in Household (please include number and ages):

	
	
Pets Currently Living in Household:

Name
Cat or Dog                 
Sex (M/F)                   

Are your dogs/cats up to date on vaccines?  	(Please use back if more then 5 pets currently in home)	
If not, why not?
	
Cats at home – Have they been tested for Feline Leukemia & FIV?
When?  	
Results:
	Do they go outside? 	
Home Situation (Own/Rent):  
(If renting, attach letter from landlord indicating pets are allowed)	How many years at current residence:  	
Average number of hours a day someone is home:  		
Have you ever given up an animal before, and if so, why?  

	
Previous experience with Siamese:
If this application is being submitted with the intent to adopt another breed, please answer the following questions with that breed in mind. (example: Cornish Rex or Oriental Short Hair) 

Please see below:

Why do you want to rescue a Siamese or Siamese Mix, as opposed to getting one from a breeder?

Are you prepared to deal with the emotional and/or physical “baggage” that many rescued cats have?
Are there any emotional or physical problems that you would not be willing to tolerate?

Will you commit to continuing any special requirements that a rescued Siamese/Siamese Mix that you adopt may need, such as special diet; additional litter pans; medication, etc?  

Yes _____ No ______

If you find that you can not meet the requirements of a “special needs” cat that you adopt, will you agree to return the cat to Meezer Pleasers Siamese Rescue?
Yes ________  No __________
	
Age desired: 	Sex desired: 	Point type desired:  	
Are you interested in any particular Siamese/Siamese Mix listed on our Petfinder.com site?

Two References (Not Related):	
Name:  
	Phone
	E-mail:
	
Name: 
	Phone: 
	E-mail:
	
How did you hear about us?
	
Best time to call your references?
	
Might you be willing to foster a cat while we look for your “forever” companion?

comments:	

Before signing this Application, please be aware of the following:

•	If you adopt a Siamese or Siamese mix from MPSR, the animal may not be abandoned or relinquished to a shelter.  
•	Adopted cat(s) may be reclaimed at any time by MPSR if it is learned that the terms of your Contract are not met or if there is any falsification of information on any documents you have submitted.
•	MPSR will be more than happy to provide you with advice on any problem you have with the pet to the best of our capabilities.
•	If the Siamese or Siamese mix adopted is too young to be spayed or neutered at the time of adoption, by signing this Application, you agree to have the pet spayed or neutered at the appropriate age, providing MPSR with confirmation of the sterilization, in return for which a spay/neuter deposit, paid at time of adoption, will be refunded.
•	You agree to care for the adopted cat according to all state and city laws, including licensing requirements.
•	You agree to maintain proper vaccination of the adopted cat for rabies and distemper.
•	You understand that no refunds are given on adoption fees should the adoption not be successful, however MPSR will assist you in the selection of another cat of your choice.

I certify the above to be true and complete to the best of my knowledge.

Signature: ___________________________________________________		Date: _______________

There is a $10 non-refundable application fee (not applicable to the adoption donation) required before this application will be processed. If mailing the application please include fee. If faxing or emailing this application you may mail the fee separately. 
If this form is filled out online or as an emailed document it will be considered void if there have been any changes to the language of this form. If received by email the applicant waives their actual signature and accepts all contract language in this application by placing their initials here: ________.

Meezer Pleasers reserves the right to refuse the adoption of an animal to anyone.

Meezer Pleasers Siamese Cat Rescue, Inc.
P.O. Box 351
Shrewsbury, PA 17361
717-235-3951	P.O. Box 351
Shrewsbury, PA 17361
717-235-3951 (phone)
(215)754-4146 (fax)
meezerpleasers@aol.com 
  http://meezerpleasers.petfinder.org                                       
Veterinary Reference	
Please have your vet fill out this portion and return via fax or US mail.

I, _____________________ have applied to Meezer Pleasers Siamese Rescue (MPSR) to adopt a cat.  MPSR requires a veterinary reference to ensure an appropriate placement.  I hereby give permission for you to complete this reference form and send it to MPSR as well as to answer any and all questions that a MPSR representative may have about me and/or any veterinary care that has been provided to any animal that I have brought to your clinic. I agree to hold you harmless and free of any liability regarding any information that you might give to MPSR.

Applicant signature 	_______________________________ Date: ______________
	
Name of veterinarian: ___________________________________________________
Address: _____________________________________________________________
City: ___________________________________State ____________ZIP___________

Phone: _________________________________email: ___________________________

How long have you known this client? _______________
How many cats does he/she own?	Male__________	Female__________

Cat 1: _______________ FeLeuk date__________ Result _____ FIV date__________ Result______
			   
Date of most recent rabies vac __________ Date of most recent other vac _______________
			
	Date of spay ____________ Date of neuter _______________

Cat 2: _______________ FeLeuk date__________ Result _____ FIV date__________ Result______			   
Date of most recent rabies vac __________ Date of most recent other vac _______________
			
	Date of spay ____________ Date of neuter _______________

Cat 3: _______________ FeLeuk date__________ Result _____ FIV date__________ Result______			   
Date of most recent rabies vac __________ Date of most recent other vac _______________
			
	Date of spay ____________ Date of neuter _______________

How many dogs does he/she own?	Male__________	Female__________
Have all dogs been spayed or neutered:		Yes		No
What is your opinion of dog(s) temperament?   In general:________________________________

Re cats:  _______________________________________________________________________

Are there any reasons why you would NOT recommend placement of a Siamese with this client?

Veterinarian Signature:___________________________           Date: ____________________

Please use back, copy form, or attach an extra sheet for any additional information.