Humane Society of Jefferson County, Inc

Cat Adoption Application Cat Name______________

Humane Society of Jefferson County, Inc.

Application Procedure

We request the following information in an attempt to assist you with the selection of your companion animal. The animal’s welfare is our foremost consideration. This process is designed to help us determine if the placement is in the animal’s best interest and to assist you in finding an animal best suited to your lifestyle. H.S.J.C. reserves the right to refuse an adoption to anyone for any reason. No animal will be adopted to prospective owners who mislead or fail to provide accurate information on this application.

Please read the following information carefully.

Fill out the application completely. Identification is required to verify information.
We do not do same day adoptions.
Every effort will be made to review the application in a timely manner. HSJC staff will notify you when the process has been completed. We will contact you to inform you of our decision.
Once an application has been approved it will remain on file for 6 months.
All family members must meet the new companion animal before adoption to ensure compatibility.

Name: _____________________________Phone:__________________ Date:__________

Birth date: ______________Drivers License #_______________________State Issued___

Address: __________________________________________________________________

City ___________________________ State: _____ Zip: ________County:____________

Email address: ___________________________________

How long have you lived at this address? ___________

If there is a specific cat/kitten you are interested in? Name of cat/kitten _______________

Pre-Approve (pet selection not yet made) Yes / No

Type of residence

Circle one: House Apartment Duplex Mobile Home Park Farm

Live with friend/relative Condo Other____________________

If you rent, lease or own a condo or trailer please provide the following information:

Landlord or Condo Association: _______________________________________________

Daytime phone: _____________________ Evening phone: _____________________

Are you planning to move within the next 6 months?_____________________________

Veterinary Information (for pets owned and previously owned)

Clinic name: ____________________________________

Phone: ________________________

If you do not currently have a veterinarian, you will be asked to obtain one before the adoption is finalized.

Please list all pets in the household and pets you have owned in the past

5 years:

Species Name Age Neutered? Still own?

_________________________________________________________________________

Are the pets you now own current on vaccinations? Yes / No

Are the records listed under the name on the application? Yes / No

If you no longer own the pet, what happened to it?

_________________________________________________________________________

Have you ever adopted from a shelter before? Yes / No When?_______________

What kind of pet?___________________________________________________________

Have you ever surrendered an animal to a shelter? Yes / No When?_______________

Why?_____________________________________________________________________

What is your past experience with cats? Please circle.

First time owner Current cat owner Had a cat in the past

How will you correct behavior problems in your cat if they occur?

_________________________________________________________________________

How much $ do you plan to spend per year to care for your cat? ______________________

How many hours a day will your cat be home alone? _____________

Are you a frequent traveler? Yes / No

Who will care for your cat if you must be gone for an extended period? ______________

Where will you keep the cat during the day? _________________________________

Where will you keep the cat during the night? _________________________________

Are you willing and able to assume the financial responsibilities of pet ownership?

Yes / No

Are you prepared to commit to caring for your new cat for the next 10-20 years?

Yes / No

If you must move from your current place of residence, what will you do with your pet?

_________________________________________________________________________

Will you allow your cat adequate time to adjust to a new home? Yes / No

How long? _________________________________________________________________

Are you aware of the annual routine vaccinations recommended for the health and protection of your cat? Yes / No

Please tell us a little about your household

What is the activity level of your household? Please circle.

Quiet Active Moderate activity

# of Children ___________ Ages____________ # of Adults__________________

Who will be the primary caretaker?__________________________________________

This cat/kitten is being adopted as: Please circle all that apply.

House cat Outside cat Barn cat Gift Mouser Companion For a Child

Indoor/Outdoor Cat Companion for another Pet Breeding

Does anyone residing in the house have any known pet allergies? Yes / No

Are you familiar with the pet responsibility and liability laws in your area? Yes / No

Do you understand that all adopted cats must be spayed/neutered? Yes / No

Do you plan to allow your cat outdoors unattended? Yes / No

Do you plan to de-claw your cat? Yes / No

If yes, please circle: Front paw declaw Four paw declaw

Circle items you would like more information about.

Litter box training Cat/Cat Introductions Dog/Cat Introductions Ordinances /Laws Declawing

Cats and Children Spaying/Neutering Training Methods Vaccinations

How did you learn about our organization? Please circle.

Pets of the Week Friend/Relative Phone Book Veterinarian

Radio Special event Other ______________________

Release:
By submitting this document, you are stating that all the information given herein is accurate and complete and that you are hereby giving your consent for The Humane Society of Jefferson County to verify any and all information contained herein. The completion of this form does not entitle you to any guarantees or rights. HSJC will not be held liable in any way, for any animal, or its actions, once the animal has been placed.

Signature: _________________________________ Date:__________________

Received: Staff Initials________________ Date/Time:____________________

Office Use Only

Veterinary check _________________ Landlord approval __________________

Home ownership verified____________________ Pets licensed________________

Approved_______ Denied________Pending___________

Adopter notified___________________

Notes:

Include all correspondence relating to the adoption. Please date and initial.

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________________