Cat and Kitten Adoption Application
Applications take our Adoption Counselor typically 24-72 hours to process. You will be contacted by email or phone call; please check both your email and voicemail for potential messages. Our adoption fees for adults are $20, kittens between 4 and 8 months are $35, and $70 for kittens between 2 and 4 months (covers full vetting, spay/neuter, microchip, and care of the cat). Adoption fees are payable via cash, credit, or debit; we no longer accept checks. Fees will be paid at the time of adoption and may vary. Submitting this application does not mean you are committing to a cat, nor does it guarantee you will get that cat. It is simply a tool we use to help both you and us identify a good potential match for your family and lifestyle. A successful adoption depends on selecting the right cat for your household and a good understanding of the cat's needs and care requirements. Please help us with this process by answering the following questions fully & completely. THANK YOU!
**Please note that any fields left blank will halt the application reviewing process.
Applicant Information
Adopter #1 Name: ____________________________________D.O.B ___/___/___
Adopter #2 Name: ____________________________________D.O.B ___/___/___
Adopter #1 Phone Number ___-___-____ Email: ______________________________
Adopter #2 Phone Number ___-___-____ Email: ______________________________
Adopter #1 Are you currently employed? ______________________________________
Adopter #2 Are you currently employed?: _____________________________________
Home Address:
Street Name ___________________________ City/State/ZIP _________________
Do you live in (circle): single family duplex/twin apartment condo mobile home
Do you (circle): own rent deed/rent to own reside with relative
If you are not the owner of the home, please provide the homeowner’s information (name and contact information: __________________________________________________
How long have you lived at this residence? ________________________
List any residences you have had in the last 5 years: ____________________________
Household Information
Please list full names and ages of all permanent residents 18 and older: _________________
__________________________________________________________________
Ages of all permanent residents 18 and younger: ________________________________
__________________________________________________________________
Do you have frequent visitors between the ages of (circle):
0-5 years 6-12 years 13-18 years None of the above
Does anyone in the household have pet related allergies? __________________________
Who in the household will be the pet’s primary caregiver? __________________________
Pet Ownership
Have you adopted from the Quincy Humane Society in the past? If so, where is the pet now?
__________________________________________________________________
Do you currently have any pets? ___________________
If you currently have pets, please list them. Name, Age, Sex, Breed. ____________________
__________________________________________________________________
__________________________________________________________________
Are they up to date on vaccinations? Yes No Appointment is scheduled
Are they altered? (spayed/neutered) Yes No Appointment is scheduled
How many pets have you owned in the past 10 years? Where are they now?(Please list breed & age)
__________________________________________________________________
__________________________________________________________________
Who is your veterinarian? Clinic Name __________________ Phone: _______________
Home Life
When will you be ready to adopt a cat/kitten? __________________________________
How many hours a day will your cat be alone? Explain. ____________________________
How will you exercise/entertain your cat? _____________________________________
How often will you scoop the litter box/change the litter? __________________________
Do you plan on declawing your cat? Circle: Yes No
Why or why not? ______________________________________________________
How much do you reasonably feel you could afford/would be willing to spend on your cat per
month? (Including veterinary care, licensing, ID tags, food, toys, crates, supplies): $ ________
Ideal Cat
Please describe your ideal cat. We will be able to recommend a perfect fit based on what you say
here. _____________________________________________________________
__________________________________________________________________
What kind of cat are you looking for? Circle Indoor Outdoor Indoor/Outdoor
What Personality type are you looking for? (circle all that apply)
Party Animal: loves to play, explore and test my limits
Sidekick: good company, likes attention and playtime
Love bug: affection seeking, lap cat, enjoys quiet time together
Secret Admirer: you might not see a lot of me but I'll be thinking of you, will warm up to cuddle time with purrs and headbutts
Private investigator: stays out of trouble and will always keep your secrets, may vanish into thin air if anyone interferes with my investigation
Why do you want to adopt? (Circle)
family pet companion for child companion for other dog(s) companion for other cat(s)
breed with current cat(s) barn cat/mouser therapy cat assistance to the disabled
guard cat/protection as a gift for a friend/partner/relative
My adopted cat will (circle):
be indoors be outdoors outside during the day/inside at night roaming the farm
interacting with adults interacting with ages 0-10 years interacting with ages 11-18
be boarded for vacations stay with family for vacations go with on vacations
be given away if it’s no longer working be given to a shelter if it’s no longer working
Have you discussed this adoption with all members of the household?________________
**We will be speaking to all adult residents to confirm everyone is aware of this application process and wants to have a cat added to this family. Please do not submit this application if you are "trying to talk someone into" adopting this cat or think that "once they meet the cat they will change their mind" or "I'm getting this cat as a surprise birthday present for someone". In those circumstances, you are more than welcome to email us to discuss the cat, but we would like all adults in the home to be involved in the email discussion.
What do you feel is a reasonable amount of time for a cat to adjust to a life with you and your
family? ___________________________
How do you plan to integrate this cat into your family? ____________________________
Have you ever turned an animal in to a shelter? ________ Why? ____________________
__________________________________________________________________
What would cause you to return a cat? _______________________________________
__________________________________________________________________
Please take time to think and be honest when answering the following. What are you absolutely
NOT willing to deal with at the time of adoption or anytime during the life of the cat? Circle
litter box issues chewing counter surfing fear of men fear of women
fear of children biting jumping too rough with other pet
too much energy needs too much attention food/toy aggressive with people
whining/crying scratching furniture blindness limited sight deafness
separation anxiety diabetes special diet long term medication incontinence
requires too much training gets stressed/sick in the car doesn't know how to use stairs
can’t climb stairs due to age/health heart condition allergies
trimming nails yeast on coat/in ears eat mites fleas ticks
We will do anything necessary to help this cat adjust
What would you do if after adoption (or at any time during your cat’s life) your vet diagnosed your cat with an expensive medical condition? _________________________________
_________________________________________________________________
Do you plan on getting pet insurance? Yes No I will look into it
Are you committed to providing a responsible home for your pet’s entire life? (could be 15 or
more years) Yes No
Are you willing to sign a legal contract agreeing to pet owner responsibility? Yes No
Do you have any additional questions, comments or concerns? Anything else you would like us to know in order to help match a cat with your family? ____________________________
__________________________________________________________________
__________________________________________________________________
What is the best way to contact you regarding your application? Phone or Email
Consent:
By my signature, I certify that the above information is complete and correct and that I am at least 18 years of age. I understand that completing this application does not guarantee I will be allowed to adopt a cat and that the application is a tool to help the Quincy Humane Society determine if this cat and my family are a good fit for each other. I understand that all cats adopted from QHS will be spayed/neutered, Feline Leukemia and FIV tested, microchipped, and vaccinated prior to adoption. I authorize verification of all statements on this application, including but not limited to prior vet medical history. I understand that QHS has the right to deny my request for adoption. I understand that any misrepresentations may result in my not being approved and may lose the privilege of adopting an animal from QHS. If I am approved to adopt a cat, I agree to pay a non-refundable adoption fee and hand sign an adoption contract at the time of adoption. I understand that this application is the property of the Quincy Humane Society who reserves the right to share this information with other shelters and rescue organizations.
_____ By initialing this line I understand that QHS may conduct a background check and I agree to the above statements.
Adopter #1 Signature & Date _________________________________
Adopter #2 Signature & Date _________________________________