PVCHS Cat Adoption Application
Date
Animal you are interested in adopting
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Allie (Cat - C2023056)
Almanzo (Cat - C2020377)
Angie (Cat - C2023030)
Bella (Cat - C2022231)
Billy (Cat - C2023101)
Blossom (Cat - C2022028)
Blue Jay (Cat - C2021286)
Britney (Cat - C2023069)
Brush (Cat - C2023041)
CJ (Cat - C2023047)
Clara (Cat - C2022148)
Clarinet (Cat - C2022630)
Coal (Cat - C2021663)
Corbin (Cat - C2022434)
Cranberry (Cat - C2023096)
DJ (Cat - C2023045)
Daisy (Cat - C2023100)
Eddie (Cat - C2023103)
Ember (Cat - C2023054)
Emma (Cat - C2023099)
Evie (Cat - C2023005)
Fall Out Boy (Cat - C2023112)
Fearless (Cat - C2023058)
Finn (Cat - C2023071)
Flora (Cat - C2023043)
Flyleaf (Cat - C2023109)
Freedom (Cat - C2022416)
Frida (Cat - C2023019)
Gertrude (Cat - C2023118)
Goober (Cat - C2023080)
Graham (Cat - C2023102)
Gremmy (Cat - C2022324)
Guppy (Cat - C2022242)
Izzy (Cat - C2022594)
Jane Doe (Cat - C2021636)
Jasamine (Cat - C2022087)
Jebidiah (Cat - C2023075)
Jessie (Cat - C2023044)
Kai (Cat - C2022318)
Kate (Cat - C2023105)
Kurt (Cat - C2023074)
Lana (Cat - C2021042)
Leslie (Cat - C2023001)
Lincoln (Cat - C2023068)
Lonnie (Cat - C2023067)
Louise (Cat - C2023055)
Mackie (Cat - C2023032)
Marie (Cat - C2022024)
Marshmallow (Cat - C2023023)
Melody (Cat - C2023119)
Mercedes (Cat - C2023107)
Milo (Cat - C2023117)
Moody (Cat - C2023048)
My Chemical Romance (Cat - C2023111)
Olive (Cat - C2023076)
Otis (Cat - C2023116)
PJ (Cat - C2023046)
Panic at the Disco (Cat - C2023113)
Paramore (Cat - C2023108)
Peanut (Cat - C2023049)
Peggy (Cat - C2022671)
Peppermint (Cat - C2023050)
Phillip (Cat - C2023052)
Philo (Cat - C2023098)
Piper (Cat - C2022480)
Pippa (Cat - C2023106)
Polly (Cat - C2022745)
Portia (Cat - C2022716)
Pretzel (Cat - C2022696)
Queen Victoria (Cat - C2022698)
Rachel (Cat - C2023072)
Reputation (Cat - C2023061)
Ricardo (Cat - C2022234)
River (Cat - C2022485)
Rogue (Cat - C2023079)
Sage (Cat - C2023077)
Sammy (Cat - C2023092)
Santana (Cat - C2023070)
Sidney (Cat - C2023097)
Simon (Cat - C2023057)
Sky (Cat - C2022693)
Smokey (Cat - C2023115)
Snowflake (Cat - C2023053)
Snowy Ann (Cat - C2023093)
Spaghetti (Cat - C2023114)
Speak Now (Cat - C2023060)
Squiggles (Cat - C2023038)
Stow (Cat - C2023004)
Tabitha (Cat - C2023006)
Tag (Cat - C2023073)
Taking Back Sunday (Cat - C2023110)
Tasty Freeze (Cat - C2023031)
Test Cat (Cat - C2022307)
Thomas (Cat - C2021722)
Tinkerbell (Cat - C2023051)
Wallace (Cat - C2021306)
Warren (Cat - C2023104)
Applicant's First Name(s)
*
Applicant's Last Name
*
Street Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Email Address
*
Alternate Phone Number
Are you 18 or over?
No
Yes
Drivers License Number
Please check the main reason you plan to adopt a cat:
*
select
Companion
Family Pet
Child's Pet
Companion for another pet
Other
If you answered "other" above, please explain here:
Have you owned a cat before?
*
No
Yes
Who will be responsible for caring for the cat?
*
Do you own other pets at the current time?
*
No
Yes
If yes, please list their names, breeds, and ages.
Are your pets current on their vaccinations?
*
select
Yes
no
n/a
Are your pets spayed/neutered/fixed?
*
select
Yes
No
N/A
If you have pets, will they adjust to a new pet in the house?
select
Yes
No
Unsure
N/A
How many pets have you owned in the last 5-10 years?
What happened to them?
Veterinarian's Name
*
Veterinarian's Address, City, State, and Zip Code
Veterinarian's Phone Number
Are you familiar with heartworm and heartworm prevention?
*
No
Yes
Do you own or rent your home?
select
Own
Rent
Someone else owns the Home
Someone else rents the Home
Please select your current residence type.
select
House
Apartment
Condo
Townhouse
Mobile Home
Other
If you answered "other" above, please explain here:
How long have you lived at this address?
select
Less than one month
1-2 months
3-6 months
6-9 months
9-12 months
1-2 years
3-5 years
6-10 years
10 + years
If you rent, does your landlord and lease allow pets?
select
Yes
No
Unsure
N/A
If you rent, what is your landlord's name and phone number?
Including yourself, how many people live in your household?
Please list the ages & relationship of children who live in your home.
Is everyone in your household aware that you are planning to adopt a pet?
select
Yes
No
N/A
Does anyone in your household have allergies to cats?
select
Yes
No
Possibly
N/A
On average, how many hours per day will your cat be left alone?
How much do you think the annual medical bills will be for your cat?
select
About $100
$100 - $200
$200 - $300
$300 - $500
$500 +
What would you do if the bills went over this amount?
Will this pet be predominantly living inside, outside, or both?
select
Inside
Outside
Both
Please provide a description of this pet's living conditions.
Where will the animal sleep?
select
In bed with me
In bed with my child
In a cat bed
In a kennel / crate
Wherever he or she likes
Outside
Other
If you answered "other" above, please explain:
How will you handle litter training?
How will you handle destructive behavior?
What would you do if your cat is found urinating or defecating outside the litterbox?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?
No
Yes
If no, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?
No
Yes
If yes, please explain:
What arrangements will you make for the care of your pets in case of an emergency?
select
Leave with family/friend
Boarding
Pet Sitter
Take with me/us
Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?
select
Leave with family/friend
Boarding
Pet sitter
Take with me/us
Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
What would you do with your animal if you had to move?
select
Take him / her with me
Give to family or friend
Return to shelter
Other
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?
No
Yes
If no, please explain:
Have you ever surrendered a pet to an animal shelter?
No
Yes
If yes, please explain.
Have you ever had a pet euthanized?
No
Yes
If yes, please explain:
Adoption Terms - I hereby agree to hereby undertake with PVCHS as follows to:
1. NOT PART WITH THE POSSESSION OF THE ANIMAL EXCEPT TO RETURN IT TO PVCHS BY PRIOR ARRANGEMENT IF FOR ANY REASON I AM UNABLE TO KEEP THE ANIMAL.
*
Agree
Disagree
2. Provide proper food, water, adequate shelter, and kind treatment for my pet at all times.
*
Agree
Disagree
3. Take the animal to a veterinarian within 14 days for an examination to ensure the animal is in good health.
*
Agree
Disagree
4. Provide qualified veterinary treatment in cases of injury or illness
*
Agree
Disagree
5. License the animal in compliance with the laws and ordinances in force in the municipality in which I reside.
*
Agree
Disagree
6. NOT to allow the animal to be used for medical or other experimental purposes and NOT to allow the animal to be used for fighting.
*
Agree
Disagree
7. I understand that PVCHS cannot guarantee the health, temperament, or training of the animal I am adopting.
*
Agree
Disagree
8. I understand that animals should be closely supervised when they are with children.
*
Agree
Disagree
9. Should the animal become ill within the first 7 days, I must contact PVCHS immediately and advise them of the illness to receive free medication. I can also decide to either return the animal to PVCHS or have the animal treated by a veterinarian AT MY OWN COST. I understand the PVCHS cannot, nor will not, be held liable for any veterinarian / medical charges that I may incur.
*
Agree
Disagree
10. I understand that I may return the adopted animal for a refund of the adoption fee, minus the deposit, within the first 72 hours. Between 72 hours and 30 days, I May return the animal and receive a partial refund based on the length of time in my possession. After 30 days, I may return the animal to PVCHS, but no refund will be given.
*
Agree
Disagree
NONCOMPLIANCE: Adopter agrees to pay PVCHS the sum of $150.00 as liquidated damages in the event the terms of this contract are breached. This liquidated damage value is agreed to for the purpose of establishing the value of the animal and does not bar PVCHS from seeking return of the animal by a judicial process or other legal means. It is agreed that PVCHS retains superior title in said animal limited to and for the express purpose of assuring the animal's well-being and only exercise its superior claim in the event it appears to PVCHS that the proper and humane care as specified above are not being afforded said animal, in which case the animal may be taken through and Claim and Delivery proceeding. Adopter agrees to pay reasonable attorney's fees and court costs in the event this matter is forwarded to an attorney for enforcement.
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Agree
Disagree
By signing here, I agree that I completely understand and agree to abide by the CONDITIONS and TERMS of this contract. I certify that the information I have provided is correct and any misrepresentations of the facts will result in my losing my privilege of adopting an animal. I am authorizing PVCHS to contact landlords, associations and veterinarians. I am also aware that PVCHS cannot guarantee the health and temperament of the animal. I understand that this application is the property of the Parke-Vermillion County Humane Society Pet Adoption Center, and they have the right to approve or deny my request to adopt an animal.
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Clear