RCHS Application for Cat(s)

Ritchie County Humane Society Adoption Application - CAT
Name of Cat(s) You Wish to Adopt
Full Name

First NameLast Name
Age
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number - Home

Area CodePhone Number
Phone Number - Cellular

Area CodePhone Number
Place of Employment
Phone Number - Work

Area CodePhone Number
Do you live in a:
Do you:
If Renting: Please indicate landlord contact information
Household Setting
How long have you lived at your current address?
Describe the Activity Level in your Home
Please List all People Living in the Household (Include Name, Relationship, Gender and Age)
Does Anyone in your Household have Allergies to Animals?
Are all members of your family agreeable to Adopting a Cat?
Please List any Pets you have Currently or Within the past 10 years, this includes outside pets as well (Please include Name, Breed, Age, Spayed/Neutered, Sex, Living/Deceased)
Do we have permission to call your veterinarian for a reference check? (Please authorize vet to speak with us)
Veterinarian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Where will your cat live?

Other
Do you plan to declaw this cat?
If you move, will you look for a home where you can take your cat with you?
Please help us determine where our marketing is working best. Where did you see this cat's listing?

Other
Do you understand that we require this cat to be spayed/neuter within 30 days in accordance to WV law if cat is not already fixed upon adoption?
Do you agree to provide regular health care?
Do you agree to contact us if you can no longer keep the cat?
When will you be ready to adopt this cat?

Other
By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval.

I certify that the above information is correct, and I understand that the information will be verified.
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MonthDayYearHourMinutesAM/PM Option
Your name
Co-Applicant name (if applicable)
Should be Empty:

Ritchie County Humane Society Adoption Application - CAT