KANSAS CITY SIAMESE RESCUE Printable Adoption Form P.O. Box 1245, Lee's Summit, MO 64063 (All long-distance calls to KCSR regarding available meezers may be returned as a "collect call" to reduce costs) Date: Name: Street Address: City: State: Zip: Daytime phone: Evening phone: E-mail address: Date of birth: How did you hear about us? Are all the members of your family in agreement concerning this adoption? (yes or no) How many children are in the family and list their ages: Do you rent or own your own home? If you rent, please provide the name, address and phone number of your landlord: Other pets in the home? Please give their names/breeds: What are the maximum number of hours your pets are left alone each day? Are your pets up-to-date on vaccinations? If you own cats, have they been tested for BOTH Feline Leukemia and FIV? Have they ever tested positive for either Feline Leukemia or FIV? Are your pets spayed/neutered? (yes or no) If they are not, can you please explain? Would this cat be indoor, outdoor, or both? In your opinion, what is the most effective way to teach a cat to use a scratching post? In your opinion, what is the most effective way to train a cat not to jump on counters? If you are forced to move and would not be allowed to take your pet, what would you do? Have you ever given up an animal before, and if so, why? What age, sex, and color of kitten/cat are you looking for? Is there a particular cat/kitten listed that you are interested in? Why do you want to rescue a cat/kitten, as opposed to getting one from a breeder? Please give two (2) references not related to you (name, telephone number, e-mail address): Please list your veterinarian's name, address, and phone number for reference: Siamese Adopters Only: Do you have previous experience with Siamese Cats? If yes, give a few details: What qualities are you looking for in a Siamese? Signature:_______________________ Date:_________________ (Please include a $5.00 processing donation)

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