Sherry's CHS Kitten Adoption Appliction

Cherokee Humane Society (CHS)

Cell 678-480-0708 Sherry Thomas Adoption Coordinator

Cat and Kitten Adoption Application Form (2020)
Today's Date:*

MonthDayYear
Date
Pet's Name:*
Next Visit Date:

MonthDayYear
Date
By signing below, I agree that the animal listed above is being adopted by me as a pet for myself and/or my immediate family, If at a later date I am unable to care for this animal, I agree to contact the “current owner” described above and give them the option to reclaim this animal at no charge. I agree to care for this animal humanely and responsibly. I will provide him/her with clean and adequate shelter, food, water, and veterinary care. This animal will reside inside my home and will not be allowed to wander freely outside.
Adopter Signature*

Clear
Date*

MonthDayYear
Date
Contact Information
Applicant Full Name:*
Address*

Address

Street Address Line 2

CityState

Postal / Zip Code
County*
How long at this address:*
Occupation:*
Place of employment:*
Daytime Phone:
Cell Phone:*
Email address:*
example@example.com
Choose all that apply for this applicant:

under age 25over age 65
Co Applicant or Back up Caregiver Name:*
Relationship to Applicant:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
How long at this address:*
Occupation:*
Place of employment:*
How long:*
Daytime Phone:
Cell Phone:*
Email address:*
Family & Housing
How many adults are there in your family (their relationship to you?)*
How many children (ages)?*
Is anyone living in the home allergic to cats?*

YesNo
What type of home do you live in: single family, town home, apartment, mobile home, farm, other?*
Please describe your household:*

ActiveNoisyQuietAverage
How much do you think routine vet care costs yearly?*
What is your reason for adopting?*
Is there a cat currently in the home or visiting the home that is positive for HIV or leukemia or has an upper respiratory infection?*

NoYes
If yes, Date.

MonthDayYear
Date
Your Current Pets
What other pet(s) do you own and/or have living with you (specify type, breed, sex, weight, temperament, name, age)?*
Are these pets up to date on vaccines?

YesNo
Any monthly preventative?
Are these pets spayed/neutered?

NoYes
If not, Why?
Have you ever surrendered a pet or rehomed a pet?*

NoYes
If so, why and when?
Have you ever had a pet euthanized?*

NoYes
If so, why and when?
Have you ever declawed a cat you owned?*

NoYes
If so, why and when?
Do you own a declawed cat?*

NoYes
Have you ever lost a pet to an accident?*

NoYes
When, please explain.
Veterinarian
Veterinarian's name:*
Clinic Name:*
Address.*
Phone*
About the Cat You Wish to Adopt
Desired age:*
Desired sex:*
Desired color:*
Where will this cat live?

Indoors OnlyIndoor/OutdoorOutdoor Only
Where will your cat spend the day?*
Where will your cat spend the night?*
Who will have primary responsiblity for this pet's daily care?*
Who will have financial responsibility for this pet?*
Do you agree to provide regular health care by a Licensed Veterinarian?*

NoYes
Do you agree to have your cat Micro Chipped?*

NoYes
Do you agree to a follow up phone call regarding the adoption/pet?*

NoYes
Do you agree to keep your cat as an indoor pet?*

NoYes
I AGREE TO CONTACT CHS IF I CAN NO LONGER KEEP THIS CAT OR CARE FOR ITS HEALTH NEEDS. (CHS will help you help your cat)*
Please Initial
I AGREE THAT THIS PET MAY ONLY BE REHOMED WITH FAMILY, A FRIEND, A NEIGHBOR, OR CO-WORKER, SOMEONE I TRUST ONLY. (CHS MUST BE NOTIFIED OF THIS)
Please Initial
I AGREE TO NEVER DE CLAW THIS CAT.*
Please Initial
I AGREE NOT TO USE OR PUT ON NAIL CAPS OR SOFT PAWS ON THE CAT I'M ADOPTING.*
Please Initial
Are you willing to let a representative of CHS visit your home by appointment?*

NoYes
How much are you prepared to pay for emergency vet care?*
Are you prepared to care for this cat for up to 15 years?*
Please Initial
Please understand you are adopting a resuce cat. We can only estimate the cat's age, breed and adult weight.*
Please Initial
Personal References
Please list someone who is familiar with you, your home, and your pet(s) that does not live in your home and that is not a relative. Must be different than back up caregiver or co-applicant at the beginning of the application.
1. Name:*
Relationship (neighbor):*
Address:*
Phone:*
2. Name:*
Address:*
Phone:*
Relationship (friend or co worker):
Landlord/Property Manager:
I own my home?*

NoYes
If you rent, please give the rules governing pets and the property owner’s name and number:
Landlord/Property Manager Name:
Address
Rules Governing pets:
Please Read the Following and Sign Below
Providing CHS with this information means you are allowing a CHS Representative to call your vet, property owner, and references during the application and follow-up process. Please understand out goal is to make sure these animals are placed in good homes. The responsibility of CHS is the best interest of the animals. CHS has the right to refuse an adoption for any reason. The application remains the property of CHS.

I certify that the above information in this application is true and accurate to the best of my knowledge. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Cherokee Humane Society reserves the right to annul the adoption and reclaim the animal.

The adopted animal will reside in my home as a pet. I will provide it with quality food, plenty of fresh water, indoor shelter, affection, annual physical examination, training, monthly heartworm prevention, veterinarian visits when sick or injured, and yearly vaccination under the supervision of a licensed veterinarian.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Co applicant Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Contact Information

Family & Housing

Your Current Pets

Veterinarian

About the Cat You Wish to Adopt

Personal References

Landlord/Property Manager:

Please Read the Following and Sign Below