Cat Adoption Application - Middletown Humane Society

Name of animal you are interested in: *

Name *

First

Last

Address *

City *

State *

Zip *

Home Phone *

Work Phone

Cell Phone

Email *

Employer *

What is your current age? *

When was the last time you owned a pet? *

Why don't you own that pet currently? *

Will this be your first cat? *

Yes
No

Please list the pets you have had in the past 5 years:

Please include Name, Age, Breed, Sex, If Neutered, Still Have?, if No, Why?

Pets Owned 2

Please include Name, Age, Breed, Sex, If Neutered, Still Have?, if No, Why?

Pets Owned 3

Please include Name, Age, Breed, Sex, If Neutered, Still Have?, if No, Why?

Pets Owned 4

Please include Name, Age, Breed, Sex, If Neutered, Still Have?, if No, Why?

Please provide your veterinarian’s name, address and phone number (if known): *

Have they been spayed or neutered? *

Yes
No
I don't know

Are they current on vaccinations? *

Yes
No
I don't know

Will you keep this cat up to date on vaccinations? *

Yes
No

Have your cats been tested for feline leukemia? *

Yes
No
I don't know

Have they been tested for FIV? *

Yes
No
I don't know

Are they declawed? *

Yes
No
I don't know

If yes, where is the cat declawed?

Front paws
All four paws

What type of cat behavior would you have the most difficulty in dealing with for any length of time?

What would you do to handle this situation? Please explain:

Have you ever turned your cat in to a shelter?

Yes
No

If 'Yes', please explain:

Have you ever had a pet euthanized for medical reasons?

Yes
No

If 'Yes', please explain: (copy)

If you have pets, will they adjust to a new cat entering the house? *

Yes
No
I don't know

What would you do if the present cat or dog does not get along with the new cat?

How much time would you give the adjustment period?

Why do you want this cat?

Companion
Companion for other pet
Gift
Other - please explain:

Does everyone living in your home know about and agree with your decision to adopt a cat?

Yes
No

If not, why?

How many adults are in your household?

What are the adults' ages and relationships to you?

How many children?

Please indicate ages of children.

Does any member of your household have an allergy to cats?

Yes
No

Is someone home during the day?

Yes
No

If yes, who?

How many hours each day will the cat be alone?

Please provide details.

Where do you live?

If other, please explain:

Do you own or rent your home?

Own
Rent

If you own, who is the owner on record?

If you rent, may we contact the owner to obtain permission for this cat to live in your home?

Yes
No

Owner's name and phone number:

Where will you keep the cat? *

If other, please explain:

Do you have a cat or dog door? *

Yes
No

Will you have the cat declawed? *

Yes
No
Maybe

Are you aware of the potential side effects of declawing? *

Yes
No

If you go away for a few days, or on a vacation, who will take care of the cat? *

If you move, will you take the cat with you? *

Yes
No

Have you ever applied to Middletown Humane to adopt an animal? *

Yes
No

If yes, when?

Have you ever brought animals to Middletown Humane? *

Yes
No

If yes, please explain:

Are you willing to have a representative of Middletown Humane come to see where the cat will be living? *

Yes
No

If no, please explain:

Are you willing to take responsibility of this cat for the next 10 to 20 years? *

Yes
No

What provisions will you make for the cat should you become unable to care for him/her? *

What behavior will you have the most difficulty dealing with? *

What would you do if your cat exhibited bad behavior you didn't like? Such as chewed on your valuable items, hard to fully potty train, jumping on people, mouthing humans, hurt another pet, bite someone. *

Do we have your permission to view your social media accounts? *

Yes
No

How much are you willing to spend on medical bills for your cat? *

What would you do if the vet bills went over this amount? *

Additional comments:

Please provide two personal references (no relatives): *

Phone *

Ref #2 *

Ref Phone #2 *

Please read the following and check the box to complete the application. *

I certify the above information is true. I understand that giving false information on the application is grounds for denial of application and repossessing the dog if the application is approved. I understand the Middletown Humane Society reserves the right to deny any application.