CAPIC - CAT ADOPTION & PET INFORMATION CENTER ADOPTION APPLICATION
                          AND HOLD HARMLESS WAIVER FORM 908 393-2007

NAME___________________________________________CAT/KITTEN__________________

ADDRESS_____________________________________________HOME PH______________

CELL PH___________________________________ WORK PH_________________________

EMAIL ADDRESS__________________________________WORK EMAIL________________

Do you own your home? _________        If NO- does you landlord allow pets?  _________________   
(Lease or proof from landlord must be provided).

How long at current address?_____________________How many adults?___________________
Children?____________Ages_____________________________________________________

Do you plan on declawing this cat/kitten?       NO________       OR             YES ________
Will cat/kitten be inside cat only?____________        If no explain why not_____________________
 ____________________________________________________________________________

Other pets in home and ages ______________________________________________________
_____________________________________________________________________________

Name of current Veterinarian _______________________________City____________________

Veterinarian Phone Number ___________________________Previous vet__________________

May we call your vet for references? _________YES       OR      _________NO

Will medical/veterinarian visits be a problem financially? __________Yes    OR     _______No

Previous pet(s) owned/Ages_______________________________________________________
Reasons for death ______________________________________________________________

Have you ever given up or returned a pet for any reason? ________YES     OR      ________NO
If yes explain____________________________________________________________________

Reference____________________________________________Phone number_______________

By signing below you agree to the following. Pet ownership is a commitment and this pet(s) may live longer than 20 years. I agree to have this pet spayed/neutered (5 months and over 4 pounds) if adopted before spay/neutered and to provide CAPIC with receipt from vet.  I agree to give this pet a good home. I agree that if for any reason I am unable to keep the cat I agree to notify CAPIC.By signing this waiver I hold harmless for any reason Cat Adoption & Pet Information Center, CAPIC volunteers, CAPIC Board Officers, Trustees etc., in the adoption of this cat(s) as well as Belle Mead Animal Hospital, Cherrybrook Pet Store and its employees, or any other location if the adoption takes place on their premises. I also agree to the kitten/cat adoption rules provided by CAPIC.

Name________________________________________________Date______________

Adoption Fee ___________________________
CAPIC ADOPTION APPLICATION
Please print the below information to apply to adopt a CAPIC cat or kitten. You may also copy and paste this application and email it back to catnabber1@yahoo.com