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 Alvin Lonestar Any Cat Apollo RABBIT Apple's Fig KITTEN Apple's Rowan KITTEN Archie KITTEN Ariel RM Asher KITTEN Athena RABBIT Banjo Dixon Banski KITTEN Bao Bao RM Bash KITTEN Beckham RM Beetle Lonestar Bilberry KITTEN Binx Mama Sato Blanche Blitz RM Blue Steele Bluey KITTEN Boe Dixon Boris RM Brick Louisiana Brock Lonestar Bruce Buddy Burger Lizman Butter RABBIT Camila NJ Cedar NJ Cheesecake Chickpea Chickpea's Beans KITTEN Chickpea's Frank KITTEN Chirp KITTEN Chloe Dixon Clyde Clyde KITTEN Comer (Nedra Coco) Cooper Lizman Cow Cricket Lonestar Daffodil RM Dahlia's Joyce KITTEN Dahlia's Max KITTEN Dahlia's Mike KITTEN Dahlia's Susie KITTEN Dal Dandelion KPS Darla Darla's Gandalf KITTEN Darla's Hank KITTEN Delphine RM Dexter Lizman Diamond Beaufort Dice Athens Dimitra Dodger Lizman Dottie KITTEN Dottie Lizman Drew Steele Duffy RPS Dusty KITTEN Eevee (Strawberry Davis) Lonestar* Espresso Lizman Fife KITTEN Figgy Firefly Lonestar Fluffy Frankie KITTEN Ghost Athens Gina Granny Smith Grasshopper Lonestar Griffin Lonestar Hannah Steele Harley Quinn NJ Hennessy Mini Pittie Athens Herbie KITTEN Hershey Hershey's Kit Kat KITTEN Hershey's Snickers KITTEN Hershey's Twix KITTEN Hoot KITTEN Huck Bailey Ichabod Inara Lonestar Ingrid & Humphrey RABBITS Iris KPS Jake Lizman Jasper Lonestar Jelly KITTEN Jolie Judy KITTEN Juneau RM Junebug Lonestar Juniper Jupiter RABBIT Kardi Athens Kitty Kat RM Kiya Lizman Koa Barkville KT Dixon Kubo Lonestar Kulfi KITTEN Kyle Athens Kylie Louisiana Kylo Lonestar* Lady Lonestar Ladybug Lonestar Lana (Oreo) Layla Momma Dessin Lenny Bruce Lonestar Levi KITTEN Lila Dixon Lilo Dixon Link SCAS Little T Lola 2 RABBIT Lola Athens Lucky Havard Lula Athens Luna's Comet Rabbit KIT Luna's Mars Rabbit KIT Luna's Pluto Rabbit KIT Luna's Saturn RABBIT KIT Lyra Mae Mae Magnolia RPS Marie KITTEN Marley Lonestar Marshmallow Mason Matthew RABBIT KIT Mavi Lizman Micelle Midnight SCAS Miles Athens Miles RM Millie Barkville Milo Milo Hound NJ Mirage Bailey Misty KITTEN Misty RM Mitsy KITTEN Molly Molly Molly Mae Lonestar* Moonbeam SCAS Morris (Momo) Moshi KITTEN Mr Carson RM Mr Nubby KPS Myla NJ Mystica Nana Athens Nash Lonestar Nelson Lonestar Neville Nina Lonestar Noah Noah KITTEN Olive Garden Olive Garden’s Focaccia KITTEN Olive Mini Pittie Oliver Olivia RM Ollie (Noah) Alabama Paisley KITTEN Pajune Lizman Paris Bagel Momma Pascal Clayton Peanut Butter KITTEN Pebbles Percy Athens Percy KITTEN Petey Ward Steele Petunia SCAS Pinky KITTEN Piper Pirata NJ Pixel KPS Pong Lonestar Pongo Beaufort Poppy RABBIT Poppy RM Poppy's Shy Guy KITTEN Presto RM Prince Prince Lizman Princess Peach Lonestar Pumpkin & Spice GUINEA PIGS Queen RM Ralphie SCAS Rebel Dixon Regan Barkville Remi (Bambi) Lonestar Rico Barkville Rico NJ Rocky Roman Barkville Romeo Rose RM Rune Sadie NJ Sammy KITTEN Sandy NJ Savannah Dixon Scout KITTEN Scout Lizman Shadow/King Havard Shelby (SADIE) Shorty Lizman Simba RM Sonny RDS Stanley Martin Steele Star Stella RM Theodore Lonestar Thunder KITTEN Tinkerbell RM Tippy KITTEN Turtle NJ Vance GCH Violet Beauregarde Lonestar Wilbert Newark Winston KITTEN XP Bix 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.