An all-volunteer non-profit helping homeless cats since 2004
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Adoption Application
Have you read about
how to adopt a cat or kitten from Peninsula CatWorks
?
Peninsula CatWorks is committed to placing homeless cats and kittens in homes compatible with your and the animal's needs. Please answer all questions to assist us in our match. Your application will be reviewed by our Adoption Committee.
New Home
Name:
First:
Last:
Address:
City:
State:
AA
AE
AK
AL
AP
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip:
Home phone:
Work phone:
Cell phone:
E-mail:
How long have you been at this address?
Please select ...
Less than 3 months
3 - 6 months
6 months - 1 year
1 - 2 years
2 - 5 years
5 - 10 years
Over 10 years
Do you own or rent your home?
Own
Rent
Landlord's name:
Landlord's phone:
Pets allowed?
Yes
No
How heavy is traffic on this street?
Light
Medium
Heavy
Do your windows have screens?
Yes
No
Environment
How many adults in the home?
How many children?
Ages of children?
Does anyone in the home have allergies to cats?
Yes
No
What pets do you currently have? Please include their ages and how long you have had them.
How many hours a day will the cat(s) be alone?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Where will the cat(s) be when alone?
Where will the cat(s) be when you are at home during the day?
Where will the cat(s) be when you are home at night?
Pet Care
Who provides veterinary care for your pets?
Phone:
Who will be primary caretaker for the cat(s)?
How often does the primary caretaker travel?
Who will take care of the cat(s) in an emergency or during vacations?
Experience
What pets have you had previously? Please include their ages and how long you had them.
What happened to them?
Have you ever lost a pet?
Yes
No
Have you ever had a pet hit by a car?
Yes
No
Have you ever had a declawed cat?
Yes
No
Have you ever surrendered a pet to a shelter?
Yes
No
Please explain why you surrendered the pet.
Have you ever nursed a sick animal?
Yes
No
Please describe the illness and the care provided.
Comments
Is there anything else you want to tell us?
Feedback
Have you attended a Peninsula CatWorks Adoption Fair?
Yes
No
How did you hear about the adoption fair?
Please select ...
I saw the sign as I was walking/driving past.
I saw the announcment on www.peninsulacatworks.org
I saw a posting on Craig's List.
I saw a flyer at my vet/pet store.
I saw an ad in the Palo Alto, Redwood City or San Mateo Daily News.
I saw an ad in the San Jose Mercury News.
I saw an ad in the Palo Alto Weekly or Country Almanac.
I heard an announcement on the radio.
Someone told me about it.
Had you already decided to adopt a kitten/cat before attending the adoption fair?
Yes
No
Signature
I certify that the above information is true and understand that misrepresentations may result in the cancellation of the adoption. In providing a veterinarian reference, I am authorizing the veterinarian to disclose information to PCW.
Submit Application
CONTACT US:
info@peninsulacatworks.org
P.O. Box 70101, Sunnyvale, CA 94086-0101
(408) 831-2280