SIAMESE RESCUE ALLIANCE

ADOPTION APPLICATION

Date: ________________ Received: _____________________

Name: ___________________________________ Phone (H): ____________________

Address: _________________________________ Phone (W): ____________________

_________________________________ Cell Phone: ____________________

City: _________________________________

State: _________________________________ Zipcode: _______________________

Nearest Large City: _________________________

E-Mail: _________________________________

Past Pets - Small Animal: Yes ___ No ______

Current Pets (number/type): ___________________________________________________

Children (number/ages): ___________________________________________________

Are your dogs/cats up to date on Vaccines? ___________ Spayed/Neutered: _________________

If not, why not: ___________________________________________________________

Cats at home - Have they been tested for BOTH Feline Leukemia and FIV? _________________

Results: _________________________________________________________________

Do they go outside: ______________________ Pet(s) Names: ____________________

Vets Name: ______________________________________

Address: ______________________________________

______________________________________

Phone: ______________________________________

Home Situation: Own/Rent*? ______________ How many years at this house: ________

*        If renting, attach letter from landlord or copy of lease paragraph indicating pets are allowed.

Average # of hours a day someone is home: ___________________________

If you travel for business, how do you plan to provide for cat when away from home:

Kennel: ______ Sitter: ___________ Family/Friend: _____________

Have you ever given up an animal before, and if so, why?

__________________________________________________________________________________

__________________________________________________________________________________

Previous experience with Siamese Cats:

__________________________________________________________________________________

__________________________________________________________________________________

Why do you want to rescue a Siamese, as opposed to getting one from a breeder?

__________________________________________________________________________________

__________________________________________________________________________________

What qualities are you looking for in a Siamese:

__________________________________________________________________________________

__________________________________________________________________________________

Age desired: __________ Sex desired: __________ Points Desired: _______________

Two (or Three*) References (Not Related):

Name Phone E-Mail (preferred)

1.     ___________________________ ___________________ _______________________

2.     ___________________________ ___________________ _______________________

3.     ___________________________ ___________________ _______________________

* If you don't currently have a veterinarian, please provide a third personal reference.

Any SICC/Meezer Transport Reference?

________________________________________________________________________________

Any particular Siamese on the list that you are interested in?

________________________________________________________________________________

I certify the above to be true and compete to the best of my knowledge.

Signature: _________________________ Date: __________________________

(Applicants must be at least 18 years of age)

Please either fax, mail or e-mail to the address below with your $10.00 application processing fee.

Credit Card Payment: Card Type: AX __ VS __ MC __

Card Number: _________________________________ Exp Date: ______

_____________________________________________Your Authorization (Signature)

Adoption and related donations:

Application processing: $10

Owner Release/Cat Donation: $100 (over 10 years: $350)

Siamese Cat: $125 Mix: $100 Kittens: add $50

Senior Cat citizen (over 10 years) Discount: $50

Long Distance Transportation via air parcel or in cabin (incl. transporter expenses) $172.
    Our Contract requires:
  1. Cats be kept indoors
  2. Does not allow declawing a clawed cat.
  3. A devise in your will or a letter in your important papers accompanied by our contract, stating whom is to take your kitties in event of a change in your life's circumstances; and
  4. If the adoption does not work to the best interest of the cat and the adopter, SRA be given the opportunity to receive the cat(s)/kitten(s) back into their care.
To see a copy of our contract, please just contact us directly.

Siamese Rescue Alliance
PO Box 3088
Coppell, TX 75019
Phone: 1-866-MEOW-NOW - Fax: 1-866-SIAMES7 - Email: TXsrc@SiameseRescue.org