Adoption Questionnaire
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Page 1
Contact Information
First Name
Last Name
Street Address
Suburb
State
Postcode
Email
Home Phone
Work Phone
Mobile
Yes
No
Are you an Australian citizen?
If no, are you a permanent Australian resident?
If no, are you on a visa?
Have you owned a cat previously?
Have you adopted from Cat Protection previously?
Have you ever surrendered an animal to a pound or shelter?
If already adopted, when?
a family pet
a stray
If already surrendered, were they
Yes
Not yet, but I will
I haven't thought about it
Do you have an alternative home for your cat should your situation change?
Page 2
Adopter details
Do you live in a
House
Unit
Other
Other
Do you currently rent or own your home?
Please select...
Own
Rent
How many hours are you generally away from home each day?
What is the average level of activity in your home? scale from 1 to 5 where 1 represents quietness and 5 being active
1
2
3
4
5
Do you share your home with children?
Yes
No
If yes, how many?
Do you share your home with other adults?
Yes
No
If yes, how many?
Do you share your home with other pets?
Yes
No
If yes, specify:
You will need to provide a copy of your pet's current vaccination certificate. You can email this document to info@catprotection.org.au
Do you or anyone else in your house have allergies?
Yes
No
Cat/Kitten Details
When are you hoping to adopt a cat?
Today
This week
This month
When I find the right cat
Other
Are you adopting a cat as a friend:
For you
For another pet
For your child/children
Other
What age cat or kitten are you interested in adopting?
Kitten (2-6 mths)
Adolescent (7m - 2 yrs)
Adult (2-7 years)
Senior (8 years+)
Depends on the cat
What type of cat do you want to share your home with? (Please tick as many options as apply)
Please select...
Active
Calm
Confident
Playful
Outgoing
Quiet
Independent
Affectionate
Good with cats
Good with dogs
Good with children
Other
Other
Where will your cat live?
Inside/Outside
Inside only
Outside only
Inside/outside but indoors overnight
How did you hear about Cat protection? (please tick as many options as apply)
Please select...
Cat Affairs
Cat Protection Website
Cat Protection Facebook
Cat Protection stall at a fair day, festival or expo
Council referral
First engagement
Friend/ Relative
Internet search
Newspaper
Passing by
Previous client/ supporter
Radio
Referral from vet
Unknown
Vet clinic poster
Other
Please specify:
Clinic:
I have engaged with Cat Protection previously as a client or supporter in the following ways: (please tick as many options as apply)
Please select...
Previous adoption
Desexing client
Telephone support
Education program
Member
Donor
Volunteer
Affiliated business or sponsor
Fundraising event
Cat Protection Facebook
Cat Protection website
At a fair day, festival or expo
Other
First Engagement
Blank
Other
What days of the week are you available for an appointment? (TEST)
Please select...
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Do you currently rent or own your home?
Please select...
Own
Rent
Page 3
Privacy Policy
Your personal information is treated as confidential and we are committed to protecting your privacy. We will never sell or rent your information to a third party. For a copy of our privacy policy, please refer to our website or ask our staff for a copy.
Disclaimer and Signature
I permit Cat Protection to phone or email me to ask how my new feline/s are settling in or to make further adoption enquiries. I certify that, to the best of my knowledge, the information I have provided is true and that any information found to be false may result in my application for adoption being refused.
PRINT NAME
AFTER Printing your name, please return this tablet to a staff member.
Page 4
Staff Member Initials
Yes
No
Id Sighted
DATE
Contact Information
February, 2025
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