Date
*
MM
DD
YYYY
Name of Kitten/Cat you want to adopt:
*
Name
*
First Name
Last Name
Name of Spouse/Significant Other
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email
*
Are you 21 years of age or older?
*
Yes
No
Do you live as a dependent?
*
Yes
No
Reason for adopting this animal:
*
Family Pet
Pet Companion
Barn Cat
This pet has endured at least one traumatic change in its life already. Are you ready to make a lifetime commitment to this pet?
*
Yes
No
If you run into problems, are you committed to seeking out and paying for training and behavior work to provide this animal a forever home?
*
Yes
No
Do you currently own other animals? If yes, what type and how many?
*
Yes
No
If you have dogs, please list how many, their gender, spay/neuter status, and where they live (inside, outside, etc.).
If you have cats, please list how many, their gender, spay/neuter status, and where they live (inside, outside, etc.).
If you have other pets, please list what type, how many, and where they live (inside, outside, etc.).
If you do not presently own other animals, have you owned animals in the past?
*
Yes
No
If yes, what happened to them?
Have you ever adopted a pet from a Calvert County Humane Group?
*
Yes
No
If yes, which one?
Have you ever been denied adoption of a pet from any Humane Group?
*
Yes
No
If yes, why?
How many adults live in your household?
*
List their relationship to you:
*
How many children live in your household?
*
Ages of the children?
Are any members of your family at home during the day?
*
Yes
No
If yes, who?
Are any member of your household allergic to this species of pet?
*
Yes
No
On an average day, how many hours will this pet be left alone?
*
Who will be responsible for caring for this animal?
*
Considering the cost of vet care, food, supplies, and time, can you afford to adopt this pet?
*
Yes
No
Are you presently employed?
*
Yes
No
If applicable, is your spouse employed?
Yes
No
Place of employment:
*
Are you or your spouse in the military?
*
Yes
No
If so, and you are transferred, do you plan to take this pet with you?
Yes
No
What type of home do you live in?
*
Apartment
Townhouse
Single Family Home
Mobile Home
Do you own your home?
*
Yes
No
Do you lease your home?
*
Yes
No
Does your lease allow pets?
*
Yes
No
Not Applicable
If your lease allows pets, how many?
Will the pet you are adopting stay:
*
Inside at all times
Outside part time
If kept outside part time, I acknowledge that the cat will be on a leash or harness designed for cats.
Have you or anyone in your household ever been charged with cruelty to animals?
*
Yes
No
Please provide the name, address and phone number of a veterinarian you most often use:
*
Reference: Please provide the name and phone number of an individual who knows or has knowledge of your other animal(s):
*
In the event you were physically unable to care for this pet due to age or illness who would take responsibility for the pet:
*
May a representative from our organization visit your home and contact the reference you have provided?
*
Yes
No
I have read the above information carefully and have filled out this application honestly. I understand the omission of information and/or failure to answer all questions and sign the application can result in this application being declined.
*
