CHA Cat Application

Chippewa Humane Cat Adoption Application

This application is to help us determine whether the adoption is in the best interest of the cat(s), as well as to assist you in finding the animal most compatible with you, your home, and your lifestyle. Thank you for taking the time to read and complete this application and go through our adoption process

Please fill out this application completely.

In order to be considered for an adoption you must:
- Be 21 years of age & have verifiable identification.
- Have knowledge & consent of all adults living in your household.
- Have landlord's consent to bring an animal onto your property.
- Understand that CHA has the right to deny or approve an application at its discretion.
- Understand that applying does not guarantee approval nor does it reserve animals for you.
- Understand that we process applications as quickly as possible, but the process can take several days to complete.
- Complete all blanks on this form. Missing information will delay or disqualify your application.
Are you 21 or over?*

YesNo
Date of Birth*

MonthDayYear
Date
Full Name*
Primary Phone*
Secondary Person (if applicable)
Secondary Phone
Email Address (Please use an email you check often)*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip
Time lived at this address*
Place of Employment*
Occupation*
Time with Current Employer*
Are other people in your home experienced with cats?*

YesNo
Does everyone in the house want to get a new cat?*

YesNo
Household activity level*

QuietActiveVery Active
Please list the names and ages of other members in your household:
Name 1
Age 1
Name 2
Age 2
Name 3
Age 3
Name 4
Age 4
Name 5
Age 5
Name 6
Age 6
Name 7
Age 7
Name 8
Age 8
Do you live in a:*

HouseApartmentMobile Home (Own)Mobile Home - Which Park?DuplexDormOther
Which Park?
Do you:*

OwnRentLive with Family
If you rent or live with family: Landlord's Name
Landlord's Phone Number
We will call to verify Pet Policy
Do you have the homeowner's permission to have a cat?*

YesNo
Are you aware of any restrictions that would prevent you from adopting a cat?*

No RestrictionsLandlord PermissionMust be DeclawedMust be Spayed/NeuteredAge Restrictions
Pre-Adoption Questions (please answer all)
What type of cat are you looking to adopt? (If you know the name of the cat, list it here)*
Who is this pet being adopted for?*

Myself/My FamilyFor friend as gift
Why have you decided to adopt?*
What will you do to ensure you will be a responsible owner?*
What do you know about the breed(s) you want to adopt (breed characteristics, potential health issues,*
What happens if you get another animal that doesn't like this animal?*
What happens if it has accidents in the house?*
Do you plan to spay/neuter?*

YesNoN/A-already done
Do you plan to breed?*

YesNoN/A
Do any family members have allergies?*

YesNo
Have you applied to adopt from CCHA or another animal shelter before?*

YesNo
If yes, when and where?
Have you ever brought an animal to a shelter?*

YesNo
If yes, why?
Have you ever given an animal to another person?*

YesNo
If yes, why?
Are there any life altering events in your near future (baby, moving, divorce, job layoff)?*
If you move in the future, what will you do with the cat?*
What problems would make you want to return the pet? (Check all that apply)*

Litterbox issuesBiting/ScratchingChewingShyness/Fear HidingClawing FurnitureOther
How do you plan to deal with: Aggression, Shyness/Hiding, Play biting, Scratching (furniture or people), Climbing on furniture/counters, Chewing plants/cords*
Are you willing to deal with unforeseen circumstances this pet may present?*

YesNo
This cat will be:*

inside onlyoutside onlyinside & outside
If you checked Inside & Outside or Outside only please explain:
Do you intend to declaw this cat?*

NoFront DeclawFront & Back Declaw
Reason
Do you understand that declawing can cause chronic pain, litterbox issues, biting, aggression or personality changes in the cat?*

YesNo
How experienced do you feel in securing veterinary care for a cat?*

No experience - but I am eager to learn!Some experience - I know how to find a veterinarianI have a vet that I use and love!Other
When adopting an unneutered or unspayed cat from CHA, it is required to have the cat spayed/neutered Are you prepared financially and willing to comply with this policy?*

YesNo
It may take the new pet a month or longer to adjust to your home. Are you prepared for this adjustment period?*
Are you committed to spend 12- 20+ years providing health care, food, grooming & attention to the cat?*

YesNo
In the boxes below, please list all pets you have owned in the last five years (including those no longer with you), and all pets currently living in the home (this includes pets belonging to roommates, etc
Animal 1
Animal 2
Animal 3
Animal 4
Animal 5
Animal 6
If you no longer have any of the pets listed above, please explain what happened to them:
* If you have not owned any pets in the last five years, and there are no pets currently living in the home with you, please check here

Check here
Are your pets up to date with vaccinations?

YesNoI don't know
What Vet Clinic do you use?
Phone
What is the pet owner's name on the account at the vet clinic?
Please Read Carefully and Sign: The undersigned applicant hereby grants the Chippewa Humane Association permission to confirm any information provided in this application with any appropriate third-party source, including landlords, veterinarians, etc. The information obtained will be held in confidence and used only by the Chippewa Humane Association for purposes of this adoption application. I certify that all the information on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected. I also understand that this adoption application is at its own discretion. It is specifically understood that the Chippewa Humane Association reserves the right to deny any adoption application at its own discretion.
Signature

Clear
Date

MonthDayYear
Date
Reference 1
Name and Number
Reference 2
Name and Number
Should be Empty: