ADOPTER INFORMATIONFirst and Last Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Alt Phone Email* Alt Email ANIMAL TO BE ADOPTED INFORMATIONAnimal's Name Gender Species Breed Estimated Age Color / Markings Where did you first see this pet?Pet FinderAdopt-a-petFacebook/Social MediaCARE WebsiteAdoption EventOther Care EventOtherAPPLICATION QUESTIONSAre you able to provide the long term care a cat requires? Yes No Are all the adults in the family aware of the adoption and committed to this pet's care? Yes No Does your current house/apartment allow a cat? Yes No If you will be moving, are you committed to finding a place to live which allows you to keep this pet? Yes No Do you have children under the age of 18 living in your household? Yes No If yes, please provide the ages:Do you plan for this cat to be indoors, outdoors, or indoors/outdoors? Indoors Outdoors Indoors/Outdoors How do you plan to exercise this dog? (Check all that apply) Walk Fenced Yard Other (Please specify below) Other If you have ever had to give up the ownership of a pet, please list the circumstances and what you did with the pet? (ex. find a new home, turn in to a shelter, turn in to a rescue group, etc.)CURRENT/PAST PET INFORMATIONDo you currently have pets in the household? Yes No If yes, please list their names, age, and species:If no, have you ever owned pets before? Yes No If you answered yes to the question above, please list their names, age, and species of the pets you previously owned in the last five years:Please fill in the following information if you currently have a dog in the household. If you do not currently have a dog, please fill in the information regarding the last dog you owned. If you have never owned a dog please skip to the next section. Have your current cats been to the vet within the past year? Yes No Are your cats up to date on Rabies vaccine? Yes No Are your cats up to date on RCP vaccines? Yes No Are your cats spayed/neutered? Yes No Do your cats take monthly heartworm prevention? Yes No Do your cats take monthly heartworm prevention?Do your cats stay indoors, outdoors, or indoors/outdoors? Indoors Outdoors Indoors/Outdoors Have all your other pets (including dogs, horses, etc.) been to the vet within the past year? Yes No Are all of your current pets up to date on vaccines? Yes No VETERINARIAN INFORMATIONPlease fill in the following information if you currently have a veterinarian. If you do not currently have one, please fill in the information regarding the last veterinarian you used. If you have never owned a pet before please skip to the next section. Name of Veterinarian Clinic Name Clinic's Phone Number Please have your current veterinarian fax us your current pet's or most recent pet's medical records to (864) 972-9963. This will help ensure a quick application process. ADOPTION AGREEMENT I agree that this animal is being adopted for myself/my family, not as a gift for someone else and that I am at least 18 years old. I agree to provide for the needs of this pet through his or her lifetime including food, water, shelter, and veterinary care. If at any time I am unable to provide for this animal, I agree to either return him/her to Crossroads Animal Hospital/Crossroads Animal Rescue (CAH/CARE); surrender him/her to a rescue group (not a shelter or rescue who euthanizes healthy animals); or find another home who will provide for his/her needs. If this pet is returned to CAH/CARE, there will be no refund of the adoption fee. I understand CAH/CARE makes no guarantee about this animal’s health status or temperament. If this pet is not already spayed/neutered, I agree to have this surgery done by the time the pet is six months old. This requirement can be waived only with a written statement from the pet’s veterinarian stating that spay/neuter surgery is medically contraindicated. If you fail to have this surgery done by six months old (unless advised differently by your vet), we reserve the right to take back ownership of the pet. I understand that future medical care of this pet is my financial responsibility, including illness or injury that occurs shortly after adoption or any injury/illness known to be present at the time of adoption. This pet appears healthy at this time (or as indicated above under “Known Medical Problems”), but CAH/CARE makes no guarantee to future health. By submitting this form you understand and agree to the terms listed above. You also agree that the information presented is true to the best of your knowledge. Again by completing this form, you are not obligated to adopted. The application is part of the approval process.Confirmation* I Agree Please use this comment section to provide any additional information you deem necessary to your application:EmailThis field is for validation purposes and should be left unchanged.
