Cat Adoption Application

CAT ADOPTION APPLICATION

Thank you for visiting the Olympic Peninsula Humane Society.  This questionnaire will help us to help you select the right pet for your particular lifestyle.

Adoption fee includes first vaccination, surgical sterilization, free health examination certificate, rabies vaccination and a microchip with local and national registration.

At the time of adoption you will be issued a free health examination certificate good at many veterinary offices on the North Olympic Peninsula. Please use this certificate within 3 business days of your adoption.  If the animal is determined to be ill by the veterinarian during this period, you may return him or her to the shelter for a full refund.  Failure to use this is certificate could result in forfeiture of the opportunity for refund. You may choose to treat any illness found; however, OPHS will not be responsible for any veterinary charges.

Applications are kept on file for 60 days.

Name:_____________________________________

Phone#: Home _________________Cell _________________

Physical Address:_______________________________________________________________________________                                   Street                           City                State                               Zip

Do you live in a: 0 House  0Apartment   0 Mobile Home  0Condo  0 Duplex  0 With Parent/Relative   Other____________________________

2. Do you: 0 OWN  0 RENT 

3. Landlord Name:_____________________________________  Phone:_______________________________

4. How long have you lived at your current residence?____ Do you plan on moving within the next 6 months?_____

5. If you move in the future what will you do with your pet(s)?____________________________________________

6. How many adults live in the home? _______ How many children? _______ Children’s ages: ________________

7.  Who will be responsible for the cat? ________________________________________________________

8. Why are you adopting this cat? Check all that apply.              0My companionship        0Family companionship       0Gift           0Mouser         0Breeding              Other?__________________________________________

9. Have you adopted an animal from us before? _____ When? _________________Do you still have the animal?_______  If not, what happened to the animal?____________________________________________________________

10. Do you have a fenced yard?  ________ What type of fencing?_____________________________________

11. Where will the cat live?  0 strictly inside  0 strictly outside  0 both inside and outside

12. Where will the cat sleep at night?        0 inside       0 outside

13. How many hours a day will the cat be left alone?______________

14. Where would the cat stay when you are not home? Check all that apply.   0 loose inside     0 confined inside      0 loose outside     0Kennel/run/fenced area outside

15. Describe your home’s activity level?  0 busy, active, noisy  0 moderate coming and going       0 quiet

16. Would you spay or neuter this cat? _________________ Why?_______________________________________

17. Would you declaw this cat? _____________________ Why?  ________________________________________

18. Are you aware that it costs an average of $200 – $500 a year to own a cat?  _____________________________

19. Have you ever surrendered a pet to an animal shelter?______  When?_______ Why?_____________________

20. How much time will you allow your new cat to adjust to your present pets and/or new home?________________ __________________________________________________________________________________________

21. What problems would cause you to return an animal? Check all that apply.               0 house/litter box training      0 shyness/other fears     0 scratching/climbing on furniture    0 illness  Other: Please describe:____________________________________________________________________

22. Would you be committed to work with the animal to correct any of these and most other problems?____________

23. What pets do you currently have in your household?

Type       Spayed/Neutered        Kept Where          How Long Owned?        Age     #1 0 dog 0 cat   0 yes 0 no             0inside  0outside     ______________  ___________     #2 0 dog 0 cat   0 yes 0 no         0inside  0outside   _______________  ___________     #3 0 dog 0 cat   0 yes 0 no         0inside  0outside  ______________     ___________     #4 0 dog 0 cat   0 yes 0 no         0inside  0outside     _____________  ___________     #5 0 dog 0 cat   0 yes 0 no             0inside  0outside              _______________  ___________

Other:_________________________________________________________________________________________           24. Do you have a veterinarian?   0Yes  0No   Clinic Name:________________________________________

25. May we contact your veterinarian?  0Yes  0No

26. Are you willing to provide a lifetime home for this pet, medical treatment and specialized obedience training?      0Yes  0No   If not, why?_____________________________

27. Individuals who adopt an Olympic Peninsula Humane Society animal may be contacted periodically for an update to help ensure that the animal successfully adjusts to its new life.  If you adopt an OPHS animal, do you consent to home visits before and/or after adopting this pet? ___________________________

**  I certify that the above information is accurate to the best of my knowledge and understand that falsification of information can be cause for denial of my application or future forfeiture of the adopted pet.

**  Shelter staff reserves the right to deny adoption applications for any reason that does not comply with the philosophy of our organization.

_______________________________________________   __________________________ Signature of Applicant                    Date