Cat Adoption Application
We want to get to know you! Please fill out this preliminary application. An adoption Counselor will contact you. Please call 530-343-7917 X164
* Required
What cat(s) are you interested in adopting?
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Your answer
Your Name
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Your answer
Phone Number
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Your answer
Home Address
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Your answer
Current City, State & Zip Code
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Your answer
Email Address
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Your answer
Additional Owners and/or Emergency Contact Name
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Your answer
Emergency Contact Phone Number
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Your answer
How many adults live in the home?
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Your answer
How many children live in the home?
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Your answer
How will you introduce and acclimate your new cat to children? (If applicable)
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Your answer
Are you...
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Choose
Working Full Time
Working Part Time
Working Remotely
Retired
Student
Homemaker
Do you...
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Rent
Own
Your home is a....
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Condo
Apartment
Townhouse
Trailer/Mobile
House
If you Rent, does your landlord allow pets?
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Yes
No
Do not rent
If YES, how many pets are allowed (N/A if not renting)
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Your answer
Manager Phone Number (N/A if not renting)
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Your answer
Name of Landlord / Complex/ Park (N/A if not renting)
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Your answer
Amount of landlord's pet deposit? If any, has it been paid? (N/A if not renting)
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Your answer
How many pets live in your home?
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0
1
2
3
4
5
6
7
8
9
10
Please list the pets currently living in your home. Please include the type of animal and age.
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Your answer
Are your pets up to date on vaccines?
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Yes
No
Not sure
Do not have any pets
What animals have you owned in the past?
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Cats
Dogs
Reptiles
Other:
Required
What are you looking for in a new cat?
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Male
Female
Either
My new cat needs to get along with other cats
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Yes
No
May not get along with all cats
My new cat needs to get along with dogs
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Yes
No
May not get along with all dogs
I'm looking for a cat that is... (check all that apply)
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Very Playful
Somewhat Playful
Not Very Playful
Very Active
Somewhat Active
Total Couch Potato
Independent
Attached to People
in between
Required
Check any of the following reasons for adopting this cat
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Family Pet
Child's Pet
Gift
Companionship
Companion for Other Pet
Other:
Required
Is everyone in the home in favor of adopting a new pet?
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Yes
No
Unsure
Who will be responsible for daily care of your new cat?
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Self
Spouse
Children
Roomate
Other:
Required
Will this cat live...
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Indoor
Outdoor
50/50
Other:
Required
Do any of your pets spends time outdoors? if YES, why?
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Your answer
Are any members of your household allergic to cats?
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Yes
No
Not sure
Veterinarian's Name and Phone Number:
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Your answer
How much do you expect to spend annually on vet care for your cat?
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$0-$50
$50-$100
$100-$250
$250-$1000
Other:
If your cat develops a medical problem , what would you do?
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Your answer
Have any of your current or past cats been declawed?
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Yes
No
Will you declaw your new cat?
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Yes
No
maybe
How would you handle training if your cat has issues using the litter box?
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Your answer
How will you handle training if your cat has scratching and or destruction issues?
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Your answer
For which reasons below would you surrender a cat? Check all that apply...
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Cats medical problems
Personal medical problems
Moving
Ruining furniture
Scratching
Aggression
Divorce
New baby
Spraying
Shedding
Allergies
Lost job
Marriage
Children losing interest
Not getting along with other pets
Not getting along with child
Other:
Required
Are you prepared to provide a permanent loving home for this cat for 15 years or more?
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Yes
No
Required
By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of the rescue cat and possible removal of said cat from my home. I consent to Butte Humane Society representatives discussing information on this application with any persons named on this application. Applicants must be 18 years of age or older.
Butte Humane Society reserves the right to refuse any applicant for any reason. All completed applications become property of Butte Humane Society.
Your name (First and Last)
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Your answer
Date Signed
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MM
/
DD
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YYYY
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