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Provide Drivers License State and Number:
Have you ever been charged with a violent crime or abuse/neglect?
If under the age of 21 please list your parent names and phone number:
Cat Primary living situation: (Choose all that apply)
When home alone the cat will be? (Select all that apply)
Type of Residence:
Home Location: (Select all that apply)
How many pets?
Other Pets 1:
Other Pets 1 Spayed/Neutered?
Other Pets 1 Location:
Other Pets 2:
Other Pets 2 Spayed/Neutered?
Other Pets 2 Location:
Other Pets 3:
Other Pets 3 Spayed/Neutered?
Other Pets 3 Location:
Please list veterinarian name or put NA if you do not have a vet:
My cat needs to be good with: (Select all that apply)
I would be interested in adopting a pet with special needs: (behavioral or mental)
If you answered yes or unsure to the prior question, please explain:
Personal References Name and Phone: (please provide 2)
I certify that the above information is correct. I authorize the Beare Garden Plantation Animal Rescue to contact my references. I understand that this form is not a guarantee of adoption nor does it constitute an adoption agreement or contract until formally approved by BGP management. I agree to return this animal(s) if for any reason it doesn't work out in my home. I agree that BGP may decline this application for any reason at its discretion. By clicking the SUBMIT button, I am affixing my electronic signature.
Type your full name below as your legal signature: