Cat Adoption Application

Humane Society of Marion County
701 NW 14th Rd Ocala FL 34475
352-873-7387
Frontdesk@thehsmc.org

Today's Date *
List animals you would like to meet with *
Identification
First Name *
Last Name *
What is your date of birth? You must be at least 21 years of age or older to adopt. *
Please list your I.D. Number (ID, License, or Passport) *
Address *
City *
State *
Zip Code *
What County do you live in? *
Phone Number *
Email *
Confirm email
Employment
Employer *
Length of time at job:
Housing
Do you Rent or Own? *	Rent Own Other
If other, explain.
If renting, what is your Landlord's Name?
If renting, what is your Landlord's Phone Number?
If renting, do you have a pet deposit?
If renting, are pets allowed?
Current Pet Information
Leave blank if you do not have any current pets
How many pets do you have at home? *
Are all of your current pets up to date on vaccines?
List the animals by name that are currently in your home. Please include species, age, and time in family. (Ex. Daisy, Cat, 5 Years Old, with us for 6 months)
Vet's Name or Practice
Vet's Phone Number

Please list all adults and children, full names and ages below. (Ex. John Smith 21, Jane Doe 24) *
Is anyone allergic to cats? *
Is anyone allergic to dogs? *
Additional Information
Will this Cat be allowed outoors? *
Are your current cats declawed? *
Have you declawed any previous cats? *
Do you plan to declaw this cat? *
My pet must be good with: *	Children Elderly People Cats Dogs Livestock Other
I am looking for a pet that is: *	Calm Active Friendly Playful Aggressive Laid Back Other
If you relocate, move or go on vacation what will you do with this cat? *
Have you ever surrendered an animal? *
If yes, under what circumstances?
What would cause you to give up your pet? *
When no one is home, my pet will be: *	Loose in the house In the yard Runner Crate Inside Crate Outside Garage Confined in one room Barn Other
If other, explain.
When I am home, my pet will be:	Loose in the house In the yard Runner Crate Inside Crate Outside Garage Confined in one room Barn Other
If other, explain.
Humane Society of Marion County Adoption Application Agreement
*	I agree to care for the adopted animal(s) in a humane and responsible manner and to provide it with appropriate shelter, food, water, exercise, companionship, and veterinary care. I understand that HSMC takes every precaution to assure the health of its adoptable animals; however, the HSMC can make NO GUARANTEE of any kind regarding the health, temperament, breed, or behavior.
*	I affirm that no member of my household has been convicted of any animal welfare law violation such as neglect, cruelty, abandonment, etc. I understand that this adoption is conditional on providing vet records for all current/past pet(s) if need be. I understand that this adoption is conditional on a meet and greet of all required animals and required people in the home.
*	I affirm that the information contained in this form is accurate to the best of my knowledge. I understand that approval for animal adoption is up to the Humane Society of Marion County staff and that approval of this application is for this animal only. By choosing to adopt an animal, I understand that I will be required to commit considerable time and money to this animal for the remainder of its lifetime.
By signing below, I authorize the Humane Society of Marion County to contact: • My Veterinarian(s) (to check the care provided & spay/neuter history on current/past pets) • My Landlord (to ensure that I have permission to keep a pet(s) on the premises, if I have a pet deposit if I have pet rent, and if there is an agreement that needs to be signed) • My employer (to confirm my employment)
I (Name)________________agree that I am adopting solely as a pet(s) for myself and/or my immediate family living in my home. I agree that I will not sell, give away or otherwise dispose of said pet(s) to any person(s) or other entity for any reason without prior approval of H.S.M.C. If, at any time I am unable or unwilling to keep this pet(s), I agree to contact the H.S.M.C. and give H.S.M.C. the opportunity to take back the pet(s). In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal. I understand the H.S.M.C. has the right to deny any adoption at any time for any reason. I certify that all the statements made by me on this adoption agreement are true and correct. I agree that H.S.M.C. has the right to confiscate the adopted animal if any statements made by me are found to be false and/or my payment for the adoption is returned for insufficient funds. *

Cat Adoption Application

Identification

Employment

Housing

Current Pet Information

Leave blank if you do not have any current pets

Additional Information

Humane Society of Marion County Adoption Application Agreement

By signing below, I authorize the Humane Society of Marion County to contact:

• My Veterinarian(s) (to check the care provided & spay/neuter history on current/past pets)

• My Landlord (to ensure that I have permission to keep a pet(s) on the premises, if I have a pet deposit if I have pet rent, and if there is an agreement that needs to be signed)

• My employer (to confirm my employment)