Primary adopter *

First Name

Last Name

Phone *

(###)

###

####

Home address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are all current pets spayed/neutered?

Yes

No

Are all current pets vaccinated?

Yes

No

We would like permission to contact your vet

Yes

No

Before returning the dog, would you seek the help of a trainer and YHT?

Yes

Trainer

YHTSR

No

Under what circumstances would you not keep the cat?

Select all that apply.

Divorce

Illness in Family

Moving

New Baby

New Job

Potty-training Problem

Scratching Furniture/Carpet/Drapes

Scratching People

Fleas

Allergy

Shedding

Conflicts with Other Pets

Cat Became Ill

High Veterinary Costs

None of the Above