Print, fill in and return. Thank you!
| Another Chance Animal Rescue | 207-676-9330 |
| PO Box 552 37 Market Street | www.anotherchanceanimalrescue.org |
| North Berwick, Maine 03906 | |
Name ____________________________________ DOB _________ Address _____________________________
Spouse's name ___________________________________________ Mailing address ______________________
Tel. no. (day) ________________ (evening) _________________ City ________________________________
State ___________ Zip _________
Do you own or rent your home? _______; Landlord's name & no. _______________________________________
How long have you lived there? _________________; Are you planning to move? _________________________
No. of adults in home: ____; No. of children: ____; Ages: ___________; Does anyone in your family have allergies? _______________
Who is this cat for? You/family ___; Gift (for whom) ________________; Who will be responsible for the cat's care? ______________
Have you had a cat before? _____; What happened to it? _____________________________________________________
Do you have any pets now? Dogs _____; Cats _____; Other ___________________________________________
Are/were they spayed/neutered? ______________; Regular health checkups? _____________________________
Veterinary reference: _______________________________________________________________________
How long will pet be alone during the average weekday? ________; Where will pet stay when you are not home? __________________
Do you plan to let the cat outside? _________________________; Declaw it? __________________________
What will you do with the cat if you go away? ________________________; If you move? _______________
If you can no longer keep the cat, what would you do with it? ______________________________
Describe the kind of cat/kitten you are looking for (Preferred
color, age, long/short hair etc.):
I certify that the above information is true and I authorize Another Chance Animal Rescue to check my references.
Your signature______________________________________ Date________________________________
Office use:
ACAR representative _______________________________ Home check required? _______; Landlord permission _________
References: Vet. ______; Personal __________________________
Approved ___; Denied ___ (Reason) ______________________________________________________________________________
"…Because Every Animal Deserves Another Chance!"