Cat Adoption Form

All fields are required.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Daytime Phone(Required)

Own or Rent(Required)

Do you own or rent?

Own

Rent

Landlord Info(Required)

If you rent, provide landlord's contact info, including phone number and/or email address.

Why do you want to adopt a cat from us?(Required)

Why do you want to adopt a cat from us?

Do you agree to contact NHS if you are no longer able to keep your adopted cat?(Required)

Do you agree to contact NHS if you are no longer able to keep your adopted cat?

Yes

Pets you have owned in the last 5 years(Required)

Please list any pets you have owned in the last 5 years.

Reason for no longer owning the pets above(Required)

If you don't have the above listed pets anymore, please explain what happened to them.

Veterinary Reference(Required)

If you currently own animals, please list your veterinary reference where vaccination records can be found, veterinary phone number, and whose name they are under. Please contact your veterinarian and give them permission to release your records so that we may finish your pre-adoption form. Then let us know when we can call them.

Personal References(Required)

If you have no veterinary references, please list 3 personal references.

Adults in Home(Required)

Please list the names of all adults living in the household.

Children in Home(Required)

Please list number of children living in the home and their ages.

Where will your cat be kept in the daytime?(Required)

Where will your cat be kept in the daytime?

In home

Basement

Outside

Out building

Other

Where will your cat be kept at night?(Required)

Where will your cat be kept at night?

In home

Basement

Outside

Out building

Other

Do you plan to let your cat exercise outdoors?(Required)

Do you plan to let your cat exercise outdoors? Please explain.

Willing to allow adjustment period?(Required)

Rescued cats need time to adjust to a new home. Are you willing to give your new pet time to ensure proper adjustment (at least three weeks or more in many cases)?

Yes

If no, how much time will you give your cat to adjust?(Required)

If no, how much time will you give your cat to adjust?

List any unacceptable behavior(Required)

What would be unacceptable behavior in your home for you to want to give up the cat?

Are you prepared to take responsibility for your new cats entire life?(Required)

Cats can live 18 years or more. Are you prepared to take responsibility for your new cats entire life?

Yes

Additional Comments(Required)

Anything else you would like us to know?

The undersigned applicant hereby grants the Northwoods Humane Society to confirm any information provided in this application with any appropriate third party source, including landlord, veterinarian, etc. The information obtained will be held in confidence and used only by the NHS for purposes of this adoption.

I certify that all of the information is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected. I also understand that this adoption application is the sole property of the Northwoods Humane Society. It is specifically understood that NHS reserve the right to deny any application at its own discretion.

SIGNATURE(Required)

SIGNATURE

Date(Required)

DATE

Challenge(Required)

Please type FELINE to prove you are human:

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