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JCHS Special Breeds & Needs Application

Jefferson County Humane Society

Application for Special Breeds & Needs


Date
Month
Day
Year
Species/Animal Type
Cat
Dog

Type Any if no specific animal

Do you understand that this animal may require certain needs for their breed or non-life-threatening disabilities?
Yes
No

Adopter Information:

Are you 18 or older?
Yes
No
Number of Adults in your Household?
Number of Children in your Household?
Do you currently work?
Yes
No

If no type, no/unemployed/or homemaker

Do you Own or Rent?
Own
Rent

Type NA if you own

Note: 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 within a few years time?
Yes
No
It's possible
If yes, or it's possible, will your pet/pets go with you?
Yes, they will come with
No

Animal Information/Questions:

Does anyone in your household have allergies to Cats or Dogs?
Yes
No
Not sure
Who will be responsible for this pet?
Self
Spouse/Partner
The whole family (Household)
Other
Who will supervise your children or visiting children when interacting with your new pet?
In your absence, who will care for your pet?
Boarding Facility or Vet. Clinic
Adult Children
Other Family (Parents/Grandparents)
Family Friend or Trusted Neighbor
Where will your pet(s) be kept during the day?
Why do you want to adopt this pet? **Please click all that apply!**
How many hours will this pet be home alone?
0-2 hrs.
3-5 hrs.
6-8 hrs.
More than 8 hours
How will you confine your new pet to your property? Click all that apply
What type of grooming will you provide your pet? Click all that apply
Who will be responsible for socialization and training of this pet? Click all that apply
What behaviors will you not tolerate? Click all that apply
What type of activities do you envision doing with your pet? Click all that apply
What do you estimate the yearly expense of owning this pet? (Vet visits not included)
Are there any free roaming cats or dogs in your neighborhood or nearby?
Yes
No
Not sure
Do you have a safe and suitable environment to accommodate the needs of this animal?
Yes
No
Not sure
Have you ever owned your own pet?
Yes
No
Have you owned a pet within the last 5 years?
Yes
No
Do you currently have animals in your home?
Yes
No

Veterinarian Information:

Are your current pets vaccinated?
Yes
No
Are your current pets spayed/neutered?
Yes
No
Have you ever used a veterinarian or an animal organization?
Yes
No
Do you currently use a veterinarian?
Yes
No
I acknowledge and accept having a Veterinarian Background Check.
Yes
No

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
No
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:

Declawing is a harmful amputation of the last bone in each toe, akin to severing a human finger at the joint. This procedure inflicts severe, lasting pain and can lead to chronic health problems like arthritis. Declawing often results in behavior issues.
I agree
I disagree
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
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 don't agree
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15295 K4 Highway, Valley Falls, Kansas 66088

785-945-6600

jfcountypets@gmail.com

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