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