Please list all the cats you are interested in adopting. If open to best fit, please put "general application" *
Within the past two weeks, which rescues or shelters have you applied to adopt a cat? *
Your Previous Names Used Within Past EIGHT years:
Your Age *
Your Cell Phone, Home Phone *
Your Email *
If under age 21, please provide parent/guardian name and phone number:
Best Time/Method to contact you and/or your co-applicant? *
Employment Status * Employed Full Time Employed Part Time Retired Unemployed Social Security Disability Student Other
Name of Employer *
Please list any other source of income *
Phone *
Email
Housing - I live in a: * House Apartment Condo Mobile Home Other
If "other" please explain:
Rent or Own * Own Rent Live with Parent
Length of Time at Residence *
If you rent, you must provide your landlord's name, phone number, and the name of the apartment complex or mobile home park:
How best describes the primary pet caregiver? * Retired Stay at home parent Employed full time Employed part time College student Child
List names (first and last) and ages of ALL adults and children living full or part time in your home *
Do you or anyone in your household suffer from pet allergies? * Yes No
If yes, please explain
Is everyone in the household in agreement with adopting a new friend? * Yes No
If not, please explain why:
Do you foresee any changes in your living arrangement within the next six months to one year? (moving, vacation, live-in visitors, new baby, new pets, etc.) * Yes No
If yes, please describe:
Have you ever surrendered an animal to HSSCM or any other rescue, shelter, or animal control facility? * Yes No
If yes, please explain:
Have you ever fostered for an animal agency or friend with the intent to adopt, or did a temporary adoption which did not work out? * Yes No
If yes, please explain:
If pet is a gift, or "other" listed above, please explain:
Have you ever personally owned a cat for which you were either primarily or jointly financially responsible for the cat's vet care and all other daily care needs? * Yes No
What kind of cats have you had exposure to? (i.e. long-hair, short-hair, males, females, shy, inside/outside, outside, special needs) *
Please list ALL pets currently in the home by pet name, species, age, spayed/neutered, inside/outside, etc.) *
Please list ALL animals no longer living with you that you have had within the past EIGHT YEARS including pet name, breed, age, how long you owned the animal, and date of death or reason pet is no longer living with you: *
If you travel, who will care for your pets? *
What ages of cat are you interested in adopting? *
What gender are you looking for * Male Only Female Only Open to Best Fit
What length of fur do you prefer * Long Hair Short Hair Open to Best Fit
Are you looking for a specific breed of cat? * Yes No
If specific breed, what knowledge do you have of that breed?
Would you consider a special needs cat (physically handicapped, extremely shy, etc.)? * Yes Not at this time Maybe if it's the right fit
Do you want a declawed cat? * Yes No Front Declawed All Four Foot Declawed No preference
Do you intend to declaw your new cat if not already declawed? * Yes No
Please explain why you will declaw and how you will make your decision to declaw or not *
List any other characteristics you want in your new cat:
Please list any other unwanted behaviors:
Are you prepared for a 20+ year commitment to a cat, and would you still be able to care for this cat if your home or family situation changed? * Yes No
Who will take care of your cat in case of your illness and/or death? *
How many hours per day will your cat be left alone? *
Please describe the cat's access to the outdoors: *
Will the cat be restricted to a certain area? If yes, please explain: *
Will the cat be living at the address you provided? * Yes No Other
If "no" or "other" please explain:
Please list ALL veterinary clinics (name, location, phone number) you have used for the past EIGHT years, and if your current or previous pets might be under another name than your current first and last name. Please note, many veterinarians require prior authorization for HSSCM to request veterinary references. You may need to call your vet to provide authorization. *
Do you use flea/tick/heartworm preventative? * Yes No
Brand/Frequency:
Are your current pets in your home up to date of vaccinations? * Yes No
If not, please explain:
Are any of your current cats in your home declawed? * Yes - front foot Yes - four foot No
Are your current animals licensed and micro-chipped? * Yes No
If no, please explain:
Are you interested in having the current pets in your home microchipped? Yes No
Submitting an application for adoption constitutes agreement to HSSCM verifying your current pets' or past pets' reproductive status and health with the veterinary clinics listed on this form. Do you acknowledge this requirement? * Yes No
Please list the first name, last name, phone number and relationship of a non-relative reference who does NOT live in your home. *
Please list the first name, last name, phone number and relationship of a non-relative reference who does NOT live in your home. *
Please provide any additional information you feel would be helpful in processing your application:
Please type your name and date below to have your application signed digitally. By typing your name below, you understand that this application is the property of HSSCM. HSSCM is a private entity and not affiliated with any other humane society, shelter or rescue. Your information will not be used for anything other than processing your application for adoption. This information will be documented in our secure database and not shared with any third-party agencies. You are not obligated to adopt from HSSCM, nor does it obligate HSSCM to adopt to you. You are verifying all information provided is true to the best of your knowledge. Falsifying information will result in nullifying your application. *