JCHS Adoption Application

Species/Animal

Cat

Dog

Animal Name:

Name of animal of interest

Adopter Information

Are you 18 or older?

Yes

No

Ages of children/teens

First name

Last name

Occupation/Work

Contact Phone #

Alternate Phone #

Email

Address

Apt./Unit #

City

State

Zip Code

Do you rent or Own?

Own

Rent

If you rent, with whom or with what company?

**Type Own if you Do Not Rent**

Landlord or Company #

The landlord’s name and phone number are required to complete your adoption application. Applications missing this information may not be reviewed.

Are you planning on moving this year?

Yes

No

If yes, will you take your pet with you?

Yes

No

Animal/Pet Questions

Does anyone in your home have allergies to cats or dogs?

Yes

No

If yes, please explain how you plan on controlling allergies.

Who will supervise your children or visiting children when interacting with your new pet?

Self

Partner/Spouse

Older children (Teenager)

Other family members

**Check all that apply above**

Who will be responsible for this pet?

Self

Partner/Spouse

The whole family

Other

In your absence, who will care for your pet?

Family members

Veterinary/Boarding facility

Neighbors/Friends

I don't know

**Click all that apply above**

How many hours will this pet be home alone?

0-2

3-6

7-10

More than 10

What type of grooming will you provide your pet?

Who will be responsible for socialization and training of this pet?

What do you estimate the yearly expense of owning this pet?

Are there any free roaming cats or dogs in your neighborhood or nearby?

Yes

No

Idk

Veterinarian Information

Have ever owned your own animals?

Yes

No

Please list below all the animals you have had in the past 5 years, including those currently living in your home. (Type NA if None) [Pet’s Name] – [Breed/Type, e.g., Labrador Retriever] (Year or “Currently living in my home”)

If you no longer have any of the listed animals, please explain what happened to them

Are your current pets spayed or neutered?

Yes

No

Are your current pets vaccinated up to date?

Yes

No

Have you used a Veterinarian before?

Yes

No

If you answered yes, who was your last Vet? (Name or Clinic Name)

Your current veterinarian's name and phone number are required to complete your adoption application. Applications missing this information may not be reviewed.

Who is your current or preferred Veterinarian? (Name/Clinic)

Vet/Clinic Phone #

Whose name is your Veterinarian clinic under?

I knowledge and accept having a Veterinarian Background Check.

Yes, I accept

No, I don't accept

JCHS Terms & Understanding

Have you ever applied to adopt from Jefferson County Humane Society?

Yes

No

Have you ever brought one of your pets to Jefferson County Humane Society?

Yes

No

Do you fully understand that it may take several weeks — or even longer — for a new pet to adjust to a new home?

Yes, I understand

No, I don't

I understand and agree that should the pet not be a suitable fit for my family or me for any reason, I will promptly contact Jefferson County Humane Society by email or phone before returning the adopted animal.

Yes

No

We receive discounted food from Hill’s and would like to share your contact information (name, address, phone number, and email) so they can send you information and coupons by email.

Yes, please

No thank you

*AGREEMENT NOT TO DECLAW CATS:

By adopting a cat from Jefferson County Humane Society (JCHS), I agree not to declaw the cat or allow anyone else to do so. If I breach this agreement, ownership will immediately revert to JCHS.

Yes, I agree to terms

No, I do not agree

I further agree to pay JCHS liquidated damages in the amount of $500, in addition to all veterinary expenses arising from declawing-related complications, as well as any attorney fees and court costs incurred in the enforcement of this agreement.

Yes, I agree and understand the terms

No, I do not agree

By typing your name below, you agree to the terms of the JCHS Adoption Application.

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Month

Day

Year