Date picker

JCHS PetSmart Adoption Application

Cat/Cats Name Interested in?

Are you 18 or older?

Yes

No

# Of people in your household?

# Of Adults?

# Of Kids?

Ages of kids? (NA Type 0)

First name

Last name

Address

Apt. #/Letter

City, State, and Zip Code

Do you own or rent?

Own

Rent

If you rent, please place the landlord's or Companies Name and Location

Landlord/Company Phone #

Email

Home Phone #

Cell Phone #

Occupation

Does anyone in your household have allergies to cats?

Yes

No

Don't Know

If yes, please explain

Are you planning on moving in the next year?

Yes

No

If yes, are you taking your pet/pets with you?

Who will be responsible for this pet?

Self

Spouse/Partner

Kids

Other Family Members

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

Self

Spouse/Partner

Other Family Members

In your absence, who will care for your pet?

Veterinary Clinic or Boarding

Spouse/Partner

Other Family Members

Neighbor/Trusted Friend

Where will your cat(s) be kept during the day and night?

Indoors Only

Outdoors Only

Indoors and Outdoors

Are you planning on Declawing?

Yes

No

If yes, explain why?

How will you confine your new pet to your property?

Indoors (Free roam house)

Indoors (Kennel or Crate)

Indoors and Outdoors

Shop/Shed/Garage/Barn

What type of grooming will you provide your pet?

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

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

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

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

Have you ever owned your own animals?

Yes

No

Please list all the animals that you have had in the past 5 years, including the ones currently living in your home. (Names, Ages, Dogs, and Cats)

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

Have you used a Veterinarian before? If so, who?

Veterinarian

Are your current pets spayed or neutered?

Are your current pets vaccinated up to date on vaccinations?

Who is your current or preferred Veterinarian or Clinic?

Veterinarian

Veterinarian/Clinic Address (Or City)

I knowledge and accept having a Veterinarian Background Check.

Yes

No

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

Yes

No

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

Yes

No

If yes, please explain why?

Please understand it may take your new pet several weeks to adjust to your home... Are you prepared to allow this much time to adjust?

Yes

No

Yes, I understand that if, for any reason, the pet won't work out for my family, I will return the animal to Jefferson County Humane Society.

Yes

No

We receive food for our dogs and cats through Hills at a very reduced cost. Hills would like to be able to send our adopters information and coupons. It is our understanding they will do this through emails however we will be providing your name, address,

Yes Please

No Thank you

*AGREEMENT NOT TO DECLAW CATS:

By adopting a cat from Jefferson County Humane Society, I acknowledge and agree to never declaw the cat or allow anyone else to do so. Any violation of this agreement will result in immediate transfer of ownership back to Jefferson County Humane Society.

Yes, I agree to the terms

No, I don't agree to the terms

I further agree to pay JCHS $500 in liquidated damages, all veterinary expenses related to declawing complications, and any attorney fees and court costs incurred to enforce this agreement.

Yes, I agree

No, I do not agree

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

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.