Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Are you a citizen of The United States? *

You must be a citizen of The United States to proceed with adopting a cat from KitTea Cat Lounge

Yes

No

On a Work Visa

On a Student Visa

Date of your KitTea Cat Lounge Visit *

MM

DD

YYYY

Why are you looking to adopt a cat? Check all that apply *

Companion for myself and/or spouse

Companion for my child/children

Companion for my pet

Barn Cat

Mouser

Gift

To replace a lost cat

Do you have any of the following? Check all that apply. *

Unscreened Windows

Unscreened Door(s)

Pet Door

None of the above

I certify that all of the above information is true and accurate. I understand that if I adopt a pet from KitTea Cat Longe, this online form will become part of the adoption record. *

Yes

No

Unsure

Signature *

First Name

Last Name

Date of Signature *

MM

DD

YYYY