2. Name of Cat:
3. Name of Applicant:
How long have your lived at this address?
What is Your Age?
4. Do you want this cat for yourself or someone else?
5. Describe in detail the cat you’re looking for:
6. Describe the pets that you currently have:
7. Have they been Spayed or Neutered?
Describe the pets that you have had in the Past:
9. Are your pets current on vaccinations?
10. Have they been tested for Feline Leukemia?
Tested for FIV?
11 (a). Are they declawed?
Yes No Dont Know
11 (b). Under what circumstances would you have the cat declawed? Are you aware of the potential side effects of declawing a cat?
When a cat is declawed, the procedure actually AMPUTATES the first joint of each paw. This is a serious and very painful operation. As a result, cats often experience a
lifelong propensity to BITE, since it is their only defense, and may experience permanent balance problems, since they've had the ends of their toes removed. There are many alternatives to declawing, and we will be glad to discuss them with you.
RCHS will not release a pet to an adopter who intends to declaw their cat.
12. Have you ever turned your cat in to a shelter? Please Explain.
13. What happened to the pets you no longer have?
14. Have you ever had a pet euthanized? Please explain.
15. If you have other pets, how will they adjust to a new cat?
16. Why do you want this cat?
Companion?, Companion for other pet?,
House pet? Barn cat? Mouser? Office cat? Other? Please describe.
17. How many adults are in your household?
18. How many children are in your household? What are their ages?
19. Does anyone in your family have allergies to cats? How would you manage this?
20. What kind of home do you live in?
House Apt Mobile Home
21. What is the activity level in your home?
Quiet_?, Some activity, but usually quiet?, frequent vsistors, including children ?, lively atmosphere?,lots of indoor activities, with comings and goings? Please describe.
22 (a). Do you Rent or Own?
22 (b). Do you have the Landlord's permission to have pets?
22 (c). What is your landlord's name, address, and phone number?
23 (a)What is your occupation?
23 (b) What is your employer's name, address, and phone number?
24. Does your job require extensive travel?
25. Where will your cat live? In the house? Outdoors? With free access to
both indoors and outdoors? In the barn? In the garage?
Ideally a cat should live indoors. Outdoors they are subjected to many dangers such as dogs and other animals, traffic, and diseases. An indoor cat has a much longer life.
26. Do you have a Cat or Dog Door? Where does it lead?
27. Will you keep the cat up-to-date on vaccinations?
28. What is your veterinarian's name, address and phone number?
29. If you go away for a few days, or on a vacation, who will take care of
30. What arrangements will you make for the care of your pets in case of an
emergency, or if you become unable to care for him/her?
31. If you move, will you take the cat with you?
32. Are you willing to have a representative of Rutherford County Humane Society come to seeIf not, why?
where the cat will be living?
33. Are you aware that cats can live 15 to 20 years and are you willing to take responsibility for
this cat for the next 10 to 20 years?
34. If the cat becomes severely ill or injured, do you have the financial resources to care for it?
35. If you have any additional information that you think we should know, please type it here.
36. Please provide two personal references:
36 (a)Reference 1; list name, address, phone number and email address.
36 (b) Reference 2; list name, address, phone number and email address.
Sometimes, for reasons beyond anyone's control, the adoption does not
work out. In this case, the animal must be returned to RUTHERFORD COUNTY
HUMANE SOCIETY. Adoption fees may be refundable, at the discretion of
By signing this application, I attest to the fact that I am 21 years of age or older, and that the above information provided is correct, to the best of my knowledge. RCHS and adopter agree to accept typed in names (electronic signatures acknowledging approval of this agreement, to be the equivalent of actual signatures of the parties.