Pet You’re Interested
City, State, Zip:
Address & Phone:
Relative or Alternate
Contact Phone (day & night):
List all pets currently in your home.
Please include, breed(s), age, health, sex, and spay/neuter, and
personality. Have these pets ever
been around other animals? How do they react to other animals?
Have you or any other
family member ever owned a dog/cat or any other animal?
How long did you/they
have this pet(s)?
Why do you/they no longer
have this pet(s)?
Were there any problems
with this dog(s)/cat(s)or other animals? If so, please describe
Were you able to find
solutions to these problems? Please describe.
If you had problems with
your new pet (chewing, biting, etc.), how do you plan to handle the problem?
Please list family members who will assist
in providing daily care for this pet (feeding, play, etc.)
Length of time at address
Live with parents
Housing type: House
Landlord name Landlord phone
there any restrictions on this property regarding animals? If so, please
state all restrictions.
If you lease or rent
your home, we require the name and number of your landlord or a copy of the
agreement to confirm the
pet ownership policy.
UTA CCC cats must be
kept as indoors pets only. Do you agree to this?:
long will your pet be alone each day?
(Home all day)
7-10 hours daily Away
Preferred Age of your new
Age is not as important
as overall health and personality of the dog/cat:
We can only provide a possible age range,
due to the unknown age of most rescued dogs/cats.
Is this agreeable to you?
provide a personal reference from someone not living in your home.
currently have pets, or have had pets, please list your veterinary
How long have you been a
City and State:
UTA Campus Cat Coalition
I would be interested in
providing temporary foster care for UTA CCC:
I would like to help the cats in rescue care
making a monetary donation:
donating needed items (brushes, collars,
food, bedding, kennels, etc.)
I am unable to donate but will be glad to
tell others about UTA CCC
I have special skills or services that I can
donate/offer to the rescue effort:
If yes, please describe:
I understand that available dogs for
adoption through UTA CCC
may be either mixed breeds or
purebreds. These cats are only being described as cats that have various
physical characteristics similar to and representative of a particular
breed. I also certify that all information I have provided is correct to
the best of my knowledge, and I have not knowingly omitted or falsified any
Signature & Date
Please Print Your Full Name