Cat Adoption Application & Waiver

Adopter Information

Thank you for wanting to add one of our cats to your family!
Cat Applying For:
Your Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Primary Phone *

Area Code Phone Number
Phone Type *
Secondary Contact Phone *

Area Code Phone Number
Phone Type *
E-mail *
Are you 18 or over? If not, parent/guardian info is required. (Please keep in mind if you wish to adopt an animal, our adoption age is 21. Please refer to our adoptions team for more info) *

Yes No
Birthday *

Month Day Year
Date
Please answer the following to the best of your knowledge
What does your home environment consist of? *

Dogs Cats Children 1-6 years old Children 7-12 years old Children 13+ None
Please list the names, ages, and your relationship to all the people living in your home: *
Does anyone in the house have allergies/asthma? *
Do you live in a *
Do you own or rent your home? *

Own Rent Live with Parents
If you rent (or lease to own) please list the name and phone # of landlord and/or manager of any homeowner, condo or other similar associations, apartment, or park manager: *
If you notated that you live with your parents or other family member, please list the home owner's name and phone number: *
What do you plan to do with your cat if you move? *
Your Availability

This does not schedule you for an appointment, the Adoption Team will contact you by phone to set up any appointments.
What are the best times for you to come into the facility for a meet & greet or possible adoption? *
We will contact you to confirm or set up your appointment based off the above answers.
Where will your pet be:

(You can choose more than one)
When people are home? *

Inside Outside Crate
When no one is home? *

Inside Outside Crate
At night? *

Inside Outside Crate
How many hours will your pet spend home alone in a day? *
Who will primarily be responsible for pet care? *
Who will care for your pet if you go out of town? *
Who will care for your pet in case of an emergency? *
Is this pet going to be a gift? YES/NO? If so for whom? *
I am adopting a companion pet today because *
Training and Pet Care
What is your level of cat experience? *

Never owned a cat Owned a cat before
How long are you willing to give your pet to adjust and learn in your home? *
Do you understand that adopting a kitten is at least a 10-15 year commitment? *
What noise level/lifestyle is your household? *

Low Moderate Active Very Active
What are you looking for in a cat? (i.e. cuddly, playful, adventurous etc.) *
If your cat demonstrates destructive behavior, (i.e. scratching furniture) what is your training plan? If none, we are happy to help! *
Sometimes cats have “out of box” accidents, would you like help coming up with a plan? Yes/No? *
Under what circumstances would you return your pet? *
Please tell us who/what you would like your new pet to get along with: *

Large dogs Small dogs Cats Children Infants
If they don’t get along with one of these, what are your correcting plans? *
What do you expect the overall cost of ownership to be? (Please consider food, vet visits, emergency care, etc.) *
Have you recently lost a pet or had a pet pass away? What was the cause? *
Have you ever re-homed, surrendered, given up, or returned an animal? *

Yes No
If so, when and why? *
Current Pets

Please list all pets in the home (if no pets owned, just put none)
Do you have any current pets in your household? *

Yes No
What types of pets do you currently have in your household? Please list their name, their breed/type of pet, and if they are male or female. *
Are the above animals spayed or neutered? If no, please list which pet(s) and why. *
When were the above animals last given their vaccinations? *
Do the above pets live inside/outside? *
How long have you owned the above pets? *
If you own a cat, is it declawed? *
Do you know what declawing is? *
Do you plan on declawing the cat you are applying for? *
Who is your Veterinarian or Vet Clinic? *
Please list your vet's contact information: *
Does HSMSC have your consent to contact your veterinarian? *

Yes No No current pets
Without consent to contact your veterinarian, we unfortunately cannot go farther in the adoption process. Please make sure you allow us to help you in the adoption process as much as possible by providing your vet's information and allowing us to verify your current animal(s) care.
Do any animals in your home have any medical problems (FIP, FIV, FeLV, Parvo, etc.)? *

Yes No
Are you a current HSMSC volunteer or foster parent? *
Any additional information we should know?
How can we help you feel more prepared to bring your new addition home? *
How did you hear about us? *
Would you like to receive information on Friends of the Humane Society? For $12/month, you can help save animal lives and receive a free t-shirt! *

Yes No
Please read the following carefully. Please initial each one.
I understand that once this application has been turned in to the adoption counselor, the answers I have provided may not be changed. *
I understand that I am adopting a living creature and as such the Humane Society of Memphis and Shelby County can make no guarantees as to the temperament and/or health of this animal. *
I understand that I must take my pet to the vet at least once a year for rabies vaccines that are state required. *
I understand that I must take my pet to the vet for heartworm prevention. *
I understand that owning an animal means that I will have to pay for food, vet bills, and anything else that my new pet may require. Normal annual cost of pet ownership for a healthy adult animal is about $750. It can be more for young or senior animals. *
I understand that the Humane Society of Memphis and Shelby County reserves the right to deny any application. If my application is not approved,it is not for reasons of personal bias but for the welfare of our animals and part of the HS policies set forth. *
I certify that I am not under the influence of alcohol or any other substance. *
I certify that all statements and answers on this application are true and that any false information may result in denial of this application. *
Date *

Month Day Year
Date
Name *

First Name Last Name
Driver's License Number *
Driver's License State *
Signature *

Clear
Should be Empty:

Adopter Information

Please answer the following to the best of your knowledge

Your Availability

Where will your pet be:

Training and Pet Care

Current Pets

Please read the following carefully. Please initial each one.