PVCHS Cat Adoption Application

Date

Animal you are interested in adopting *

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?

Drivers License Number

Please check the main reason you plan to adopt a cat: *

If you answered "other" above, please explain here:

Have you owned a cat before? *

Who will be responsible for caring for the cat? *

Do you own other pets at the current time? *

If yes, please list their names, breeds, and ages.

Are your pets current on their vaccinations? *

Are your pets spayed/neutered/fixed? *

If you have pets, will they adjust to a new pet in the house?

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? *

Do you own or rent your home?

Please select your current residence type.

If you answered "other" above, please explain here:

How long have you lived at this address?

If you rent, does your landlord and lease allow pets?

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?

Does anyone in your household have allergies to cats?

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?

What would you do if the bills went over this amount?

Will this pet be predominantly living inside, outside, or both?

Please provide a description of this pet's living conditions.

Where will the animal sleep?

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?

If no, please explain:

Have you ever been convicted of abuse or neglect of a child or animal?

If yes, please explain:

What arrangements will you make for the care of your pets in case of an emergency?

If you answered "other" above, please explain:

What will you do with the animal when you go on vacation?

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?

If you answered "other" above, please explain:

Are you willing to take responsibility for this animal for the next 10-20 years?

If no, please explain:

Have you ever surrendered a pet to an animal shelter?

If yes, please explain.

Have you ever had a pet euthanized?

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. *

2. Provide proper food, water, adequate shelter, and kind treatment for my pet at all times. *

3. Take the animal to a veterinarian within 14 days for an examination to ensure the animal is in good health. *

4. Provide qualified veterinary treatment in cases of injury or illness *

5. License the animal in compliance with the laws and ordinances in force in the municipality in which I reside. *

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. *

7. I understand that PVCHS cannot guarantee the health, temperament, or training of the animal I am adopting. *

8. I understand that animals should be closely supervised when they are with children. *

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. *

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. *

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. *

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. *