First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email

Select the name of the cat you are interested in from the drop-down below. If you do not have a specific cat in mind, please select "EHR CAT" from the list.*
Choose an animal: *Any Dog Ace RM Any Cat Apollo RABBIT Apple Jacks GCH April KITTEN Athena Lizman Athena RABBIT Athena RPS Aurora LPA Bandit NJ Banski KITTEN Beaux Louisiana Becket (Zippy) Lonestar Beckham RM Binx Mama Sato Blanche Blinky KITTEN Blue Steele Boe Dixon Boron GCH Bree Louisiana Brock Lonestar Buddy Bumblebee Lonestar Bunny Butter RABBIT Camacho Lizman Camila NJ Candy RM Cedar NJ Cheesecake Chickpea Chiva Lonestar Clancy (Dixon Clayton) Cleo RM Clyde Coco Lizman Comer (Nedra Coco) Cookie Cooper Lizman Cow Crow Lonestar Daffodil RM Dahlia's Joyce KITTEN Dahlia's Max KITTEN Dahlia's Mike KITTEN Dahlia's Susie KITTEN Dale Louisiana Darla Darla's Gandalf KITTEN Darla's Hank KITTEN Darla's Ludo KITTEN Dash NJ Dave KPS Deon Dior Lizman Deputy Lonestar Dexter Lizman Diamond Beaufort Dimitra Dino Dixon Dodger Lizman Dolly Albania Dottie Lizman Drew Steele Duffy KPS Eevee (Strawberry Davis) Lonestar* Elektra RM Ella KITTEN Elma Lonestar Espresso Lizman Faith Lonestar Fandango Fife KITTEN Figgy RM Fluffy Garrett Lonestar Gina Ginger Lonestar Goldie Lonestar Grace Lonestar Grady SCAS Granny Smith Griffin Lonestar Guava GCH Gus Lonestar Gypsy Lonestar Hannah Steele Hennessy Mini Pittie Athens Hermione Dixon Hershey's Kit Kat KITTEN Hershey's Snickers KITTEN Hershey's Twix KITTEN Holly Albania Houdini RM Huck Bailey Ichadob Inara Lonestar Ingrid & Humphrey RABBITS Jack LPA Jake Lizman Jelly KITTEN Jelly Lonestar Jolie Juniper Jupiter RABBIT Justice Lonestar Kasia Kit Kat Kitty Kat RM Kiya Lizman Koa Barkville Kubo Lonestar Kylo Lonestar* Ladybug Lonestar Lana (Oreo) Layla Momma Dessin Lila Dixon Link SCAS Little T Lola 2 RABBIT Lucky Havard Luna Luna (Bimini Lonestar) Luna Athens Luna's Comet Rabbit KIT Luna's Mars Rabbit KIT Luna's Pluto Rabbit KIT Luna's Saturn RABBIT KIT Lyra Madison NJ Mae Mae Maggie Momma GCH* Marigold RPS Marley Lonestar Marshmallow Mason Mavi Lizman May KITTEN Micelle KITTEN Miles RM Millie Barkville Milly Lonestar Milo Milo Hound NJ Minnie SCAS Mirage Bailey Misty RM Mittens Molly Molly Mae Lonestar* Morris (Momo) Motley Dixon Mr Carson RM Mystica Nature Athens Neville KITTEN Noah Nova LPA Olive Garden Olive Garden’s Focaccia KITTEN Olive Garden’s Mozzarella KITTEN Olive Lonestar Olive Mini Pittie Olivia RM Ollie (Noah) Alabama Paisley KITTEN Pajune Lizman Paris Bagel Momma Pascal Clayton Peanut Butter KITTEN Pebbles Petey Ward Steele Pinky KITTEN Piper KITTEN Pirata NJ Pong Lonestar Pongo Beaufort Poppy RABBIT Prince Prince Lizman Princess Blossom Athens Pumpkin & Spice GUINEA PIGS Queen RM Raven Lonestar Regan Barkville Remi (Bambi) Lonestar Rico Barkville Rocky Roman Barkville Romeo Roo SCAS Rook Lonestar Rose RM Rune Sam SCAS Sandy NJ Scout Lizman Shadow/King Havard Shelby (SADIE) Silk Snow White Lonestar* Sparkle Spot Frances Stanley Martin Steele Star Tate Lonestar Teddy Athens Tia Toro GCH Trixie KPS Trixie Louisiana Tulip RPS Tulip's Earl Grey KITTEN Tulip's Espresso KITTEN Tulip's Latte KITTEN Turtle NJ Vance GCH Violet Beauregarde Lonestar Wallee Louisiana Whitnee GCH Wilbert Newark Winky KITTEN XP Blue - Bangor, PA XP Honey & Socks - Jefferson Twp, NJ

Please list the names of other cats you may be interested in:

Have all adult household members (Spouse/Partner, Roommate, Parents, etc.) agreed upon adopting a pet?*
Choose one: Yes No

List ALL people living in the home (not listed above) and include the following for each: (1) Full Name, (2) Relationship to Applicant (3) Age . If not applicable, enter "none":*

Date of Birth: *

Occupation:*

Do you own or rent your home?*
Choose one: Rent Own I live with my parents Other

If other, please explain

If you own your apartment, condo or townhouse, provide the name and phone number of the Homeowners Association and/or Property Management Company. We will need to contact them to inquire about any pet, breed and size restrictions.

If you currently rent, please comment on your ability / level of dedication to finding pet friendly housing for the duration of the cat's life. If you own, please say "N/A."*

How long have you been living at your current address?*

Landlord or Leasing Office (A representative from Eleventh Hour Rescue will contact your landlord to confirm that pets are permitted)

Landlord or Leasing Office Address

Landlord or Leasing Office City

Landlord or Leasing Office State/Province

Landlord or Leasing Office Zip code/Postal code

Landlord or Leasing Office Phone

Has anyone in your family ever been allergic to cat hair? If yes, please explain how this will be managed.*

Have you ever owned a pet before?*
Choose one: Yes No

Have you ever applied or adopted from Eleventh Hour in the past?*

REHOMED A PET?: We understand that occasionally there are circumstances where a pet can no longer stay in the home. Have you ever had to give up a pet? What were the circumstances, and what was the outcome for the pet? If you have never rehomed a pet, enter "none".*

If you currently have animals or have had them in the past please list each animal and include: 1) name, 2) breed, 3) number of years owned, 4) if they are neutered/spayed, 5) if up to date on vaccines, 6) if they are still with you or the reason they are no longer with you. If they have passed away, please include the year they passed and the cause of their passing. If you have not had animals, please type 'none'.

Veterinarian Name (CONTACT THEM AND GIVE PERMISSION TO RELEASE INFORMATION TO US)

Veterinarian City and State

Veterinarian Phone

If you have taken your animals to more than one veterinarian, please list each veterinarian (name, city, state and phone number)

Provide THREE (3) personal references. 

Appropriate references are friends, neighbors, clergy, and co-workers. One reference may be a relative that DOES NOT live in the same home as you.

IMPORTANT: Please inform your references immediately upon completion of this application that we will be calling them. 

Reference 1 - Full Name:*

Reference 1 - Relationship to Applicant:*

Reference 1 - Phone Number:*

Reference 1 - City and State:*

Reference 2 - Full Name:*

Reference 2 - Relationship to Applicant:*

Reference 2 - Phone Number:*

Reference 2 - City and State:*

Reference 3 - Full Name:*

Reference 3 - Relationship to Applicant:*

Reference 3 - Phone Number*

Reference 3 - City and State:*

Are you prepared for the additional cost of food, cat litter and veterinary care?*
Choose one: Yes No

Will the animal be an Indoor/Outdoor pet?*
Choose one: Indoor Only Outdoor Only Both indoor and outdoor

If you own other cats, do they live indoors, outdoors or both?*
Choose one: Indoor Outdoor Both I have no cats

Are you going to declaw the cat?*
Choose one: Yes No

Do you currently own or have you ever owned a cat that was declawed?*
Choose one: Yes No I have no other cats

Some cats may need retraining to enforce appropriate litter box habits and scratching behavior. Are you able to retrain the cat if needed?*

On average, how long will the cat be left alone each day?*

What arrangements will be made for the cat if you are away?*

If there is a new addition to the family (child, grandchild, etc), how will this impact the cat's life? *

What circumstances would result in you returning the cat to us?*

Please select "yes" to agree to our adoption policy regarding returned cats. Eleventh Hour Rescue stands behind our cats for their entire lives. If you become unwilling or unable to keep the cat at any point after adoption, you must return it to Eleventh Hour Rescue. You cannot re-home the cat on your own or surrender it to another agency. If you decide to adopt, you will be signing a legal contract agreeing to this.*
Choose one: Yes No

Do you have a plan for the long-term care of your cat in the case of your death or permanent disability? If so, Please explain. If not, enter "none". *

Anything else? If you have any specific questions or concerns, please let us know. If you have trouble sending this form, please email cats@ehrdogs.org.

ELEVENTH HOUR RESCUE RESERVES THE RIGHT TO DENY ANY APPLICATION BASED ON OUR STANDARDS AND POLICIES AND THE REASON FOR THE DETERMINATION IS CONFIDENTIAL.