Jellybean

Jellybean is a little female grey and brown tabby with white, born on May 1, 2026. She has an adorable personality and is just waiting for the right family to come along and adopt her!!!! Indoor cat only! The adoption fee is $75. HIJ

Jellybean is located in Western North Carolina. Optional transport is available weekly. If your application is approved, we will contact you regarding cost and delivery if you wish to transport the pet to your location for a cost.

To adopt Jellybean, please submit this adoption application.

Cat Adoption Application

This is a multi page form. Please complete each page before clicking “Next” to proceed to the next page. Please complete all four pages and submit the form. We will get back to you ASAP. If you need to stop and come back to the form later, click ‘Save and Continue’ A link will be provided for you to return and complete this form from any computer.

1Applicant Information

2Home Environment

3Your Plans For this pet

4References

Phone

This field is for validation purposes and should be left unchanged.

Today's Date(Required)

MM slash DD slash YYYY

automatic current date to show on PDF

Cat's Name:(Required)

I am aware that all of RCHS pets are located in Western North Carolina, but that transport is available for a cost.(Required)

Yes

Applicant's Name(Required)

First Last

Email(Required)

Spouse or Partner's Name

First Last

Children living in the home

Name

Age

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Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Cell Phone

Applicant's Age(Required)

21 years of age or older

Applicant's Occupation(Required)

Employer

Name

Address

Phone

How long have you lived at this address?:(Required)

Residence Ownership(Required)

Rent

Own

Do you have permission from your landlord to own a companion animal?

Yes

Landlord(Required)

Name

Address

Phone

What type of environment do you live in?(Required)

Rural

Suburb

City

What kind of housing do you live in?(Required)

House

Apartment

Mobile Home

Do you currently have pets?(Required)

Yes

Describe the pets that you currently have:

Name

Age

Species/Breed

Sex

Spayed/neutered

Current on Vaccinations?

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Have your cats been tested for Feline Leukemia?

Yes

Have your cats been tested tested for FIV?

Yes

Are they declawed?

Yes

Don’t know

Describe the pets that you have had in the Past

Name

Age

Spayed/neutered

Reason for giving up/cause of death

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Have you ever turned your cat in to a shelter? Please Explain

Have you ever had a pet euthanized? Please explain.

If you have other pets, how will they adjust to a new cat?

Why do you want this cat? Companion?, Companion for other pet?, House pet? Barn cat? Mouser? Office cat? Other? Please describe.

Companion?

Companion for other pet?

House pet

Barn cat

Mouser

Office cat

Other

Please describe why do you want this cat?

What is the activity level of your household?

Busy

Visits by friends

Meetings

Children

Parties at home

Noisy-TV, stereo, machinery, tools

Kids playing

Moderate-normal comings and goings

Quiet-homebodies

Few guests

Where will your cat live?

In the house?

Outdoors?

With free access to both indoors and outdoors?

In the barn?

In the garage?

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

Yes

What arrangements have you made for your companion animal(s), if you could no longer care for them (i.e.., moving overseas, extended hospital stay, nursing care facility, death)?

And, finally, please tell us a little about yourself and why you feel you could provide a good home for a rescued companion animal:

Who is the veterinarian you currently use, or used for your previous animals health issues (IF used within past 5 yrs)?(Required)

First Last

What is the Veterinarian Clinic Phone Number?(Required)

What is your veterinarian's address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Will you keep the cat up-to-date on vaccinations?

If the cat becomes severely ill or injured, do you have the financial resources to care for it?

Are you willing to allow an RCHS representative to periodically visit your home?(Required)

If no, why?

Reference #1(Required)

Name

Phone

Please provide name, address, phone number & email address of NON-RELATED personal references, whom you have known for at least 3 years, and who may be familiar with your pet ownership history.

Reference #2(Required)

Name

Phone

Please provide name, address, phone number & email address of NON-RELATED personal references, whom you have known for at least 3 years, and who may be familiar with your pet ownership history.

How did you hear about us?

Consent(Required)

I agree to RCHS conditions.

****Our goal in rescuing and re-homing animals is to provide them with a loving home for the rest of their lives. The adoption fee covers some their medical costs associated with the animal, medical and daily care during their foster period and any special care.
All animals adopted by our group MUST BE spayed/neutered prior to finalizing the placement. Most of RCHS’s adoptables are in foster care in Rutherford Co, NC.
Your signature below states that you understand any future medical costs are your responsibility and we have made full disclosure regarding our & our vet’s knowledge of the health of the animal.
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 (RCHS) at the adopter’s expense, although RCHS will try to arrange a rendezvous to minimize the adopter’s inconvenience. Adoption fees may be refundable, at the discretion of RCHS.
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.

Signature

Spouse/Partner Signature

Jellybean

To adopt Jellybean, please submit this adoption application.

Cat Adoption Application

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Blanche

Leo Pitman

Luna