Paws and Purrs Humane Society - Adoption Application


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Adoption Application & Questionaire

Date:

Name (Last, First):

Co-Applicant Name (Last, First):

Address:

City:

State:

Zip code:

Phone 1:

Phone 2:

Email Address

Birth Date:

Relationship to Co-Applicant

Home & Household Information

If you rent your home, you are required to provide verification that the landlord allows pets. If you live with your parents, you are considered a renter.

What type of Housing do you live in:

Do you own or rent:

Please list each person who resides in your home (including children + ages, roomates, friends):

Please list the pets in the past 15 years that are you were financially responsible for. Please do not list childhood pets that your parents cared for:

Please complete below information regarding current pets

Pets Name	Breed/Weight	Birthday	Sex	Fixed?	Declawed?	Indoor or Outdoor

Have you had any additional pets in the last five years? Please list the species, age and reason you no longer own them. Lost, put to sleep (reason), given away (reason).

Veterinarian Name:

Veterinarian Phone:

Have you ever adopted from us or another rescue/shelter?

Rescue name:

When:

Which pet:

Employment Information

Applicant Employer:

Phone:

Position:

Hours worked:

Shift:

Co-Applicant Employer:

Phone:

Position:

Hours worked:

Shift:

Type of cat you are interested in:

Sex of Cat:

Age of cat:

Is this cat a gift?

Reason you want to adopt:

Will the cat be allowed outside?

Do you plan to Declaw?

The adopter understands that the feline comes with no warranty as to health, temperament, future behavior, breed or appearance; and that Paws and Purrs Humane Society is not responsible should this cat bite, scratch, or harm any animal, person, or property in any way once you adopt. By signing or typing your name below, I certify that the information I have given is true. I understand that Paws and Purrs Humane Society reserves the right to deny my application for any reason at any time. I further authorize the investigation of all statements in this application.

A value is required.Signature

Additional Comments / Notes:


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