MICROCHIP#_______________________

Animal Protection Association (APA)
Cat/Kitten Adoption Application
www.apa-pets.org

Name of cat/kitten: Date:

Cat ____________________ Kitten __________________ Cat/Kitten Age:

Breed: Description:

Have ​ALL ADULT FAMILY MEMBERS ​agreed upon adopting a cat/kitten? Yes_____ No_____

Applicant Information
Name:

Street Address:

City: State: Zip:

Primary Phone: Alternate Phone:

E-mail Address: Date of Birth:

Are you presently: Employed _____ Unemployed______ Retired _____ Military _____ Student _____

Employer: / Yrs Employed____ Phone #:

How many ​adults​ live in your home? / Please list ​names​ and ​relationship to adopte​r:

How many ​children​ live in your home? What are their ages?

Are the children comfortable around animals and understand how to treat them kindly? Yes____ No ____ N/A ____

Have the children been prepared to have a new animal in the home? Yes ____ No____ N/A ____

General Information
Type of residence: House ____ Apartment ____ Condo ____ Mobile Home ___ Farm ____

Do you own or rent your home? Rent___ Own_____ If rental, are pets allowed? Yes ____ No____

If Rental, Complex Name/Address:

Manager/Landlord Phone Number:

Do you plan to move in the near future? Yes____ No ____

Do you consider your cat/kitten a part of the family? Yes ___ No ___

How much time are you prepared to allow your new pet to adjust to your home?

In the absence of the primary caregiver, who will care for the cat/kitten?

Where will the cat stay when you are on vacation or not at home?
Please Complete Both Sides of Application
Pet Information
What types of pets are currently in your care? Dogs____ Cats____ Other?_____ Describe

Have you had any pets under your care in the last five years? Yes ____ No____ If yes, please complete the chart below.

Name/Type of Pet Yrs in Spayed/ Inside/Out Where is pet now? Current on Current on monthly
your care Neutered side annual heartworm
vaccines preventative?
Flea/Tick?

Personal References
Please provide 2 references that are ​NOT​ a family member

Name: Relationship:

Phone: Best time to contact:

How do you know this person? How long?

Name: Relationship:

Phone: Best time to contact:

How do you know this person? How long?

Current and Past Veterinarian and Name of Clinic: Phone:

Have you ever re-homed a pet or returned an adopted pet to a shelter or rescue? No ____ Yes ____ If yes, why?

APA Volunteer Notes:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Animal Protection Association (APA)
702 E. 11th Street ■
​ ​ Jeffersonville, IN 47130
Mailing Address: P. O. Box 4276 ​■​ Jeffersonville, IN 47131
Phone: 812-283-6555 ​■​ Email: ​info@apa-pets.org
www.apa-pets.org​ / Facebook: www.facebook.com/APAPets/

Vicki Clark, APA President: 502-930-3095
Cindy Ehringer, Volunteer Coordinator: 502-648-8043

Adoption Agreement and Receipt
Thank you for adopting from APA. Animal Protection Association (APA) was organized in August of
1999. It is a 501c3 tax-exempt organization that operates solely on monies from donations, fundraising and
proceeds from our Thrift Store, ​Purr-fect Treasures.
The mission of APA is to rescue and secure good homes for stray and abandoned animals, promote
humane education in local schools and community to prevent cruelty to animals through spay/neuter
programs. We are an all-volunteer, no-kill cat shelter.
APA's headquarters and shelter is located at 702 East 11th Street in Jeffersonville, Indiana. The use
of this facility is leased and only cats can be housed there.
Before placing any cat, they are all spayed or neutered, vaccinated, microchipped, and tested for
FIV and leukemia. Since we are a no-kill shelter, no healthy animals are ever euthanized. We have an
outreach program at PetSmart in Clarksville for adoptions. This partnership with PetSmart has been and
continues to be a great opportunity to showcase more and more cats/kittens needing a forever home.
APA's biggest asset is its body of volunteers. There are over 60 dedicated and giving people who
give our animals so much more than basic care. We are extremely blessed in finding quality people.
Volunteers go to the shelter and PetSmart every day. They clean cages, feed, water, pet and groom the
cats, as well as, scoop litter boxes and wash/dry bedding. Volunteers also go to our thrift store every
Wednesday - Saturday. We are always in need of more volunteers, as well as, clumping cat litter, Friskies
canned cat food, paper towels and cleaning supplies. Donations can be dropped off at the shelter on
Saturdays.

Applicant Name: ____________________________________________________________________
Cat/Kitten Name: __________________________ Age:____________ Fee Paid _______________

I UNDERSTAND AND AGREE TO THE FOLLOWING BY INITIALING AND SIGNING:
1. Adopting a pet is a LIFETIME commitment. _____
2. By signing this application, I agree that all information is correct and any false and/or omission of
information, may result in the application being declined. _____
3. By adopting this pet, I agree to provide veterinary care, and any other care that may be required for
the pet’s health and well-being _____
4. By adopting this pet, I agree that APA has the right to follow up on the welfare status of the pet
including, but not limited to, in-home visits. _____
5. I agree that if any time in the future I can no longer care for this pet, he/she will be returned to APA. _____

Applicant Signature: ________________________________________________Date: ____________
APA Volunteer Approving: __________________________________________ Date: ____________
APA Volunteer Phone #: ____________________________________________