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Jefferson County Humane Society Adoption Application

JCHS Adoption Application

Species/Animal
Cat
Dog

Name of animal of interest

Adopter Information

Are you 18 or older?
Yes
No
How many adults live in your home?
1
2
3
4
More
How many kids are in your home?
0-1
2
3
4
More
Do you rent or Own?
Own
Rent

**Type Own if you Do Not Rent**

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

**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?

**Click all that apply above**

Where will your pet(s) be kept during the day?
Inside Only
Outside Only
Both (In & Out)
Inside a kennel
Garage/Barn
Why do you want to adopt this pet? **Please click all that apply!**
How many hours will this pet be home alone?
0-2
3-6
7-10
More than 10
How will you confine your new pet to your property?

**Click all that apply above**

What behaviors will you not tolerate?

**Click all that apply above**

What type of activities do you envision doing with your pet?

**Click all that apply above**

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
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

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

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
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Date
Month
Day
Year

15295 K4 Highway, Valley Falls, Kansas 66088

785-945-6600

jfcountypets@gmail.com

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