Personal Information:

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Home Phone: (Please include area code)

Work Phone: (Please include area code)

Home E-mail:

Work E-mail:

Fax Number:

Date of Birth:

Vet Information:

Vet’s Name:

Phone (Please include area code):

Address:

City:

State:

Zip Code:

Family Information:

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

Pets Currently Living in Household (please include number and type):

Pets(s) Names and Ages:

Are your dogs/cats up to date on vaccines?

Are your dogs/cats spayed/neutered?

If they are not, why is that the case?

Cats at home – Have they been tested for Feline Leukemia & FIV?

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:

Avg. number of hours a day someone is home:

Have you ever given up an animal before, and if so, why?

Previous experience with Siamese cats:

Why do you want to rescue a cat, as opposed to getting one from a breeder?

Have you ever declawed a cat?  Would you plan to declaw this cat?

Last Name:

First Name:

What you are looking for in a new cat/kitten:

Age desired:

Sex desired:

Points desired:

Are you interested in any particular cat on our site at www.nycsiamese.org ?

If you are requesting a kitten, why do you want a kitten?

Two References (Not Related):

Name:

Phone:

E-mail:

Best time to be reached:

Name:

Phone:

E-mail:

Best time to be reached:

Name:

Phone:

E-mail:

Best time to be reached:

Any NYC Siamese Rescue References?

How did you hear about us?

Would you be interested in volunteering in some capacity with NYC Siamese Rescue? 

NYC Siamese Rescue
Veterinarian Reference Form

To be filled out by your vet and sent with your completed Adoption Form.

Dear Veterinarian:

                                                                                                has applied to Siamese Rescue

to adopt a Siamese Cat. Because distance often precludes a home visit, we would like to obtain a

reference to ensure we are making an appropriate placement. We would appreciate your

time in assisting us by filling out this reference form.

Veterinarian Name:

Veterinarian Address:

                             City:                                           State:                            Zip Code:                    

Veterinarian Telephone:

Veterinarian Fax Line:

How long have you known this client?

Would you consider him/her a responsible pet owner?

To the best of your knowledge, are his/her animals up-to-date with their shots?

Were they spayed/neutered?                    Indoors/outdoors?                   Declawed?         

Have they been tested for Feline Leukemia?                                         For FIV?    

Results?

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

Any other comments?

May we telephone you if needed?

Signature:

NYC Siamese Rescue
Landlord Letter

To be filled out by your landlord and sent with your completed Adoption Form.

Tenant Name:  ________________________________________________________________

Tenant Address:   _____________________________________________________________

                               _____________________________________________________________

Tenant Telephone:  ____________________________________________________________

Landlord Name: ________________________________________________________________

Landlord Mailing Address:  ________________________________________________________

                                           ________________________________________________________

Landlord Telephone:        ________________________________________________________

I,  _________________________,  the Landlord of the Tenant premises listed in theTenant’s Address line, above, hereby certify that my Tenant ____________________________________

is permitted to have ___________ cat(s)  and/or ____________ dog(s).   To my knowledge, my tenant currently possesses  _______________ cat(s)  and/or _____________ dog(s)  and other animals __________________________________________________________________, so the Tenant may/may not adopt an additional cat for residence at the Tenant’s Address listed above. 

_______________________________________________   ________________________________

Landlord Signature                                                                  Date