Barn Buddies Adoption Form

First and Last Name

Spouse/Roommate Name(s)

City

Street Address

Unit

Postal Code

Home Phone

Cell Phone

Email Address

Living Accommodations Living Accommodations House Mobile Home Apartment Other

Do you rent or own? Do you rent or own? Rent Own Other

Landlord/Apt Manager Name & Phone Number

Do you live here full-time? Do you live here full-time? No Yes

What is the size and description of your property?

Describe the structure in which the cat will be housed

How far from the road/traffic is your barn located?

Volume of Traffic Volume of Traffic Low Medium High

Speed Limit

Is your barn a working barn/farm? Is your barn a working barn/farm? For Profit Hobby Farm

Why do you want a barn cat?

Barn cats must be securely confined for 2 – 4 weeks. Do you have an area of the barn that is secure to do this? Barn cats must be securely confined for 2 – 4 weeks. Do you have an area of the barn that is secure to do this? No Yes

Are you prepared to allow this much time? Are you prepared to allow this much time? No Yes

Who will be responsible for your barn cat’s care?

Who will care for your barn cats if you are away?

Do you agree to trap and take to the vet a barn cat that becomes ill or injured? Do you agree to trap and take to the vet a barn cat that becomes ill or injured? No Yes

Have you had pets before? Have you had pets before? No Yes

What happened to the pets you no longer have?

Do you have pets of your own at this time? Do you have pets of your own at this time? No Yes

Please enter the following information for each pet you currently own: Pet’s Name, Breed, Age, Sex, Spay/Neutered (yes/no)?, Lives Inside/outside or both, Where did you get this pet, Years Owned.

Please provide name of your small animal vet:

What other types of animals will the cats share the barn with?

Do you currently have barn cats Do you currently have barn cats No Yes

Are they spayed or neutered? Are they spayed or neutered? No Yes

If you have a dog is he permitted to run loose? If you have a dog is he permitted to run loose? No Yes

What provision(s) will be made to protect the cats?