EmailMe Form - HUMANE SOCIETY SCOTT CO. CAT ADOPTION

Cat's Name You Are Interested In Adopting:

Name *

First Last

Date Time *

MM / DD / YYYY

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone *

### - ### - ####

Email

Date of Birth (mm/dd/yy) *

Employment Status

Employed

Unemployed

Retired

Other

Work Phone

### - ### - ####

Thank you for considering adopting an orphan from our shelter. You will be making a 10-15 year commitment to the cat you adopt and our goal is to help make the best match possible for you and the orphaned cat you are interested in. The following questions will help us achieve that goal.

Do you currently live in a *

House

Apartment

Condo

Other

If other, please specify:

Do you currently *

Rent

Own

Lease the residence where you live

How long have you lived at your current residence? *

If not a property owner, Humane Society of Scott County, Indiana has my permission to verify current pet policy:

Yes

No

Landlord's Name

First Last

Landlord's Phone

### - ### - ####

How many adults live in your home? *

How many children live in your home? *

What are the ages of the children in your home? *

Does anyone in your household have allergies? *

Yes

No

Are you wanting an indoor only cat? *

Is this cat a gift? *

Yes

No

If yes, for whom?

What attracted you to this cat? *

Please list all pets you have had in the past 10 years including current pets and those you no longer own.

Breed	Age	Sex	Spayed/Neutered	Owned how long?	Is the pet still with you? If not, why?

If you have other pets, are their vaccinations current? *

Yes

No

Do you have a regular veterinarian? *

Yes

No

Veterinarian Name

First Last

Veterinarian Phone

### - ### - ####

We will review application and call you within 48 hours of receiving it.

Thank you for considering one of our orphans for adoption. Our goal is to help make the best possible match for you and the pet you are interested in.

Again, thank you for choosing one of our furbabies.

Signature

Clear

BELOW IS FOR INTERNAL USE ONLY

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