Cat Adoption Application

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

Today's Date *
List animals you would like to meet with *
Identification
First Name *
Last Name *
Drivers License or ID Number (no spaces or dashes) *
What is your date of birth? *
Address *
City *
State *
Zip Code *
What County do you live in? *
Phone Number *
Email *
Employment
Employer *
Position
Employment Length
Business Phone Number
Housing
Do you Rent or Own? *	Rent Own Other
Length of Time at Residence *
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, do you have a breed restriction?
If you relocate or move, what would you do with this cat? *

How many adults live in the house? *
How many children live in the house? *
Please list all adults and children, full names and ages below. *
Is anyone allergic to cats? *
Is anyone allergic to dogs? *
Current Pet Information
Leave blank if you do not have any current pets
Are all of your current pets up to date on vaccines?
Are all of your current pets spayed/neutered?
Are all of your current pets on Flea and Tick Preventative?
Are all of your current pets on Heartworm Preventative?
List the animals by name that are currently in your home. Please include species, age, and time in family.
Pet History
List the animals by name that are no longer with your family. Please include the past 10 years. Please include species, age, time in family, and if they are spayed/neutered. If this does not apply to you, please leave blank. *
Vet Information
Veterinarian's Name or Practice
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? *
Have you ever surrendered an animal? *
If yes, why and where?
Where will this pet stay when you're on vacation? *
How much time will you commit to fully allowing your new pet to adjust to its new home? *	Limited Time Some time A lot of time
What would cause you to give up your pet? *
Are you aware that it will cost between $50-$100 to get your new cat established? *
Who will be responsible for this Pet's care and financial responsibilities? *	Self Spouse Friend Children Parents Other
Humane Society of Marion County Adoption Application Agreement
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). * Please type your name to agree to the statement
*	I am at least 21 years of age or older.
*	I am aware that a $25 payment per animal is required to reserve the pet(s) named above. The $25 constitutes a “hold”. A “hold” may not last longer than 3 days and may be terminated by the H.S.M.C. for failure to comply/provide the requirements below.
*	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/residence/property.
*	I also 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 H.S.M.C. takes every precaution to assure the health of its adoptable animals; however, the H.S.M.C. can make NO GUARANTEE of any kind regarding the health, temperament, breed, or behavior of the animal(s) that I will adopt
*	I give my permission for an agent of H.S.M.C. to perform a home visit at my premises (where the adopted animal(s) will be living) prior to the adoption, given reasonable notice.
*	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.
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)
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. *

Cat Adoption Application

Identification

Employment

Housing

Current Pet Information

Leave blank if you do not have any current pets

Pet History

Vet Information

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)