Name*:  

Home Phone*:  Cell Phone:

Cat or Kitten applying for by name:

Cat or Kitten applying for by C or K #:

Address*:   Apt.#  

City*:

State*: AK AL AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip Code*:     Do you:   Work Attend School

Employer: Work Phone:  

Email Address:   Best number to call you weekdays? Home Work Cell  

The Humane Society:

How did you hear about us? Friend Web Newspaper Humane Society Drive-By Other If Other chosen, please explain:

Would you like to find out more about volunteering, fostering, or socializing animals? Yes  No

Have you ever had to turn an animal into a shelter before? Yes  No

Have you ever applied to adopt an animal from the Humane Society of Forsyth County?* (Must choose one)Yes  No

Have you ever adopted an animal from the Humane Society of Forsyth County?* (Must choose one)Yes  No 

If yes, who did you adopt?

Would you agree to a home visit from a Humane Society Volunteer as a condition of adoption?*(Must choose one)  Yes  No

What would be the best time(s) for a representative of the HSFC to call or come to your home to check on the cat's well being?                 

What's this about a home inspection

Your New Cat or Kitten:

Why do you want a cat?*  Family Pet/Companion Child Gift Mouser Companion for another animal Other If Other chosen, please explain:

If gift, who will be the recipient?

Does the gift recipient live with you? Yes  No

Will it be indoors, outdoors, or both?*  Indoors Outdoors Both

Where will he or she live, i.e., basement, garage, house?*       

What percentage of time will the cat spend outside?*        Inside?*  

How much time will this cat be alone (without human or other animal companionship)

Hours: Days a week:

Under what circumstances will you declaw your cat? Choose all that apply: Scratching children/people Scratching furniture Scratching carpet/rugs Other pet is declawed and cannot defend itself against one not declawed Climbing things in the house I do not believe in declawing

Other reasons why you would consider declawing:

Are all your current pets up to date on vaccines?   Yes No Some Are Does Not Apply, this is a gift Does Not Apply, this is my first animal Do Not Know

Are current pets spayed or neutered?         Yes No Some Are Does Not Apply, this is my first animal Do Not Know

If not, please explain?    

Please list all pets your family has owned in the past 10 years, including where they are now, Doctor that animal was seen by including Vet's phone number.

Do you give Humane Society of Forsyth County permission to contact vet? *

Veterinarian for your new pet:*       

Practice Name:*         Phone:*  

Pet 1: No other animals Cat Dog Bird Other Where are they now?         Does not apply Still in current household Returned to original owner/shelter Deceased Ran Away Stolen Other If other, please explain:

Veterinarian Clinic/Doctor: Contact Information - phone:

Pet 2: No other animals Cat Dog Bird Other Where are they now?         Does not apply Still in current household Returned to original owner/shelter Deceased Ran Away Stolen Other If other, please explain:

Veterinarian Clinic/Doctor: Contact Information - phone:

Pet 3: No other animals Cat Dog Bird Other Where are they now?   Does not apply Still in current household Returned to original owner/shelter Deceased Ran Away Stolen Other If other, please explain:

Veterinarian Clinic/Doctor: Contact Information - phone:

More than 3? Yes  No  If yes, you can provide Humane Society of Forsyth County (HSFC) more details later.

How much would you expect to spend yearly on routine vet visits, health care, and food for this pet?* $

(Expenditures include, annual vet checks and shots, healthy food, dental care, heartworm and flea preventative.)

A cat can live well over 10 years and requires a major commitment of time, finances, and emotion. Why do you feel you can make this commitment at this time?

*       

Your Home and Family:

How many people in your home?*  Do you have children in the home?*(Please choose one) Yes No On the way 

If Yes, what ages?  Months Year(s) Months Year(s) Months Year(s) Months Year(s)   Months Year(s) Months Year(s)

Do any members of your household have allergies? To what?

Do you rent or own home? *  Own Rent Live with Parents

If you rent, please supply Landlord's contact information:

Name:

Address:  Phone:      

How long have you lived at your current address?* Years  Months   If less than 1 year, please list previous address and time spent at previous address:  Years Months

Do you plan to move in the next 12 months?*(Must choose one)Yes  No

I understand that this application is the property of the Humane Society of Forsyth County and that the Humane Society of Forsyth County has the right to deny my request to adopt. Yes*

Do you agree to return your pet to HSFC if your conditions change and you are no longer able to care for your cat? Yes, I agree  OR No, I disagree *

Are you willing to accept this pet as a part of the family, and give it a kind and loving home?   Yes, I agree OR No, I disagree*

Are you at least 21 years of age?  Yes, I agree OR No, I disagree *  Date of birth? 

  I,                     hereby certify that all the information given is true and correct and the cat will live in my home as a pet. I recognize that any misrepresentation of facts will result in my losing the privilege of adopting a pet.*

  After pressing the Submit button, just once, wait a few moments, you will get a confirmation page     

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