Cat Being Requested ______*Adopters Must Be 19 Years of Age

The Humane Society

2 Jackson St

Binghamton, NY 13903

Phone (607) 724-3709Fax (607) 237-0234

Cat Adoption Request

Office Staff Only:12345

Application Date:

Shelter I.D.:

Adoption Date: / Initials:
Cat’s Name: / Color:
Breed: / Rabies Date:
Age at Adoption: / Admit Date:
Sex: / Altered:

Cat Being Requested ______*Adopters must be 19 years of age.

How did you hear about this cat? ______

Name ______

Name of Spouse/Roommate(s) ______

Phone Numbers: Home ______Cell ______

Email Address ______

(By providing your email address you agree to receive information from The Humane Society)

Number of People in Home: ______Adults ______Children

Age(s) of Children ______

Is anyone allergic to animals? YES or NO If yes, who & to what? ______

Physical Address:

Street ______

City ______State ______Zip ______

How long at this address? ______

Mailing Address (if different):

Street ______

City ______State ______Zip ______

Please Circle: Type of Dwelling: HOUSE or TOWNHOUSE or APARTMENT or CONDO or TRAILER or OTHER _____

List the owner of the property:

Name ______Phone # ______

Landlord Company (if apartment) ______

Your occupation (or means to support cat) ______

Why are you adopting this cat? ______

Where will the cat live? INDOOR or OUTDOOR or BOTH or CAT’s CHOICE

(Some of our cats will be able to handle being indoors only or outdoors better than others)

How many hours a day will the cat be home alone? ______

Where will the cat be while you are at work? ______

Where will the cat sleep at night? ______

Who will care for the cat in an emergency or during vacations? ______

Do you plan to declaw the cat? YES or NO Why? ______

(Some of our cats will respond better to being declawed than others)

What type of flea control do you use? ______

Please list your current pets:

NameAgeBreedName of Pet’s Vet

______

Please list anyprevious pets within the last 5 years you have personally owned, prior to your current ones.

Name Age Breed Where are they now? Pet’s Vet ______

______

If you currently have a dog(s), have they been around cats? YES or NO

Are all current pets up to date on their vaccinations? YES or NO

Are all current pets spayed or neutered? YES or NO

What name will the vet records be under?______

Primary Veterinary Office______Phone # ______

City *Please only list veterinarians who will have records of the above listed animals on file.

May we contact your vet regarding your application? YES or NO

*Please contact vet to allow release of information.*

If you do not currently have a veterinarian, who do you plan on using for veterinary care with this animal? ______

Where will the cat go if you have to move? ______

Under what circumstances would you not keep this cat? ______

Have you ever given away a pet (to a friend, shelter, etc)? YES or No

If yes, please explain. ______

Do you have experience with behavior problems in cats? YES or NO

If yes, please explain. ______

What would you do if the cat stopped using the litter box? ______

Would you allow a visit to your home by Humane Society Staff? YES or NO

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 that kind of commitment at this time? ______

______

We require 3 references, over the age of 21 years old, who can attest to your suitability as a pet owner:

Name ______Relationship______Phone # ______

I certify that the above is true and correct. I understand that misrepresentations will result in the nullification of this adoption. If providing a veterinarian reference, I am authorizing the veterinarian to disclose information.

SIGNATURE ______Date ______