Texas Siamese Rescue

SIAMESE RESCUE ALLIANCE

ADOPTION APPLICATION

Date: ________________

PLEASE FILL IN YOUR:

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 donation.

Credit Card Payment: Card Type: AX __ VS __ MC __ DS ___ DC______

Card Number: _________________________________ Exp Date: ______

_____________________________________________Your Authorization (Signature)

Adoption and related donations:

Application processing fee: $10

Siamese Cat: $150; Mix: $125; Kittens: add $50 Non-Meezer: $95

Senior Cat Citizen (over 10 years) Discount: $25 Multiple Cat Adoption: $25 Discount

Long Distance Transportation via air parcel $200 or in cabin $100 (incl. Health Certificate).

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.

If you are releasing or donating a cat to us:

Owner Release/Cat Donation: $100 (over 10 years: $350) We will make a reservation for your kitty.

In our facility. Please call to book 1 877 SAY MEOW.