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Adoption Application

If you rent what is your landlords name?

Landlords phone #:

Give a Shelter Pet a Loving Home and apply today!

If Yes do you live with your parents?
Animal species
Why do yu want a cat/dog? ( Check all that apply )
Do you own or rent your home
What kind of home do you live in?
Is anyone in your family allergic to Cats or Dogs?
Children's Ages in yor home:
Do you currently own pets?
Are all of your current house hold pets fixed? ( Spayed / Neutered )
Do you have a prefered veterinarian?

If you have a veterinarian please list their information below:

Where will your pet live/be kept during he day?
Have you ever applied to or adopted from the Jefferson County Humane Society?
Have you ever had to surrender your pet or brought one into Jefferson County Humane Society?

Please Note: It may take you new pet several weeks to adjust to your home and new surroundings.


I agree that I will not ever have declawed, or allow the declawing of, the cat that I adopt from Jefferson County Humane Society. I understand that this is a painful and unnecessary mutilation of the cat that could result in chronic paw and back pain, infection, inability to walk properly, and other physical ailments, inability to protect itself, as well as psychological problems that could result in the cat exhibiting behavior such as urinating outside the box, biting, fearfulness, anti-sociability, and aggressiveness.

I agree that if I breach the terms of this agreement that ownership of the cat will immediately revert to
JCHS and that JCHS has the right to reclaim possession of the cat. In addition, JCHS and I agree that, as it is difficult to
predict the exact costs that
JCHS will incur from caring for the declawed cat, I will be obligated to pay JCHS liquidated damages of $500, plus the cost of all veterinary care needed to deal with problems resulting from the declawing, as well as all attorney fees and court cost that are incurred in enforcing this agreement.

Thank you for your Application!

Thank you for submitting an adoption application. We will be reviewing your application and look forward to helping you find the perfect pet for your family.


If you would like to come by the shelter we are open:


Monday Closed

Tuesday 1-5

Wednesday Closed

Thursday Closed

Friday 1-6

Saturday 1-6

Sunday 4-6 ( By appointment only )



15295 K4 Highway

Valley Falls, KS 66088

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