Caroline's Kids Pet Rescue Love for Life Program Acceptance Form

Owner information: Name: ___________________________________________________ Address: _________________________________________________ City/State/Zip: _____________________________________________ Phone: ___________________________________________________ E-mail: ___________________________________________________ Pet information: Provide photo if possible Cat's name: _______________________________________________ Age: _____________________________________________________ Gender: __________________________________________________ Coat: Short ( ) Medium ( ) Long ( ) Color: ____________________________________________________ Breed: ____________________________________________________ Weight: ___________________________________________________ Veterinarian Name: __________________________________________ Veterinarian Address: ________________________________________ Veterinarian Phone: __________________________________________ Date of last visit and vaccines: __________________________________ __________________________________________________________ Any health concerns of cat: _____________________________________ __________________________________________________________ * All medical records of cat must be provided to Caroline's Kids Cat Rescue upon acceptance of the cat. * Name of attorney: ___________________________________________   Phone: ___________________________________________________ * Name of trusted family member or friend who will facilitate our acceptance of your cat:   _________________________________________________________   Phone: ___________________________________________________ Payment must be cash, check or money order. ( ) I certify the above information is true and correct Owner Signature: ____________________________________________ Date: _____________________________________________________ Acceptance by: _____________________________________________ Representative of Caroline's Kids Cat Rescue: ___________________________________ Date: _____________________________________________________