Feline Adoption Form "*" indicates required fields Step 1 of 2 50% Animal Name*Date* MM slash DD slash YYYY Name*Driver's License #*Physical Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Primary Phone*Secondary Phone*Email* Employer/Occupation*How long have you been at your current job?* Provide 2 references that are NOT members of your immediate family Reference Name*Phone*Years Known*Relationship*Reference Name*Phone*Years Known*Relationship* How many people currently reside in your household?*Any children in the household?* Yes No List Ages*For whom are you adopting the cat?* Self Gift Does any member of the family have allergies to animals?* Yes No If yes, please explain*Who will be responsible for the cat's care?*Where do you live?* Apartment Farm Mobile Home House Other Do you rent or own your residence?* Rent Own If you rent, please provide the name and phone number of your landlord*Are animals allowed at the property?* Yes No Do you plan to move soon?* Yes No What rooms/areas of your home are off limits to the cat?*Who has access to your room?* Housekeeper Yard Crew Delivery People Utility Workers Postal Worker Other Other*Where will the pet be kept while they are working?*Do you trust your workers not let the cat out?*Where will the cat live?* Indoors only Outdoors only Indoor/Outdoor Will anyone be home during the day?* Yes No How many hours will the cat be left unattended?*When no one is home, where will the cat be kept?*If you move, what will you do with the cat?*How far from traffic is your home?*Have you ever had a pet before?* Yes No Describe the pets you still care for and live in your household*NameTypeBreedAgeKept Where?Time in Your CareSpayed/Neutered?If no, why not?Describe the pets you no longer care for or no longer live in your household*NameTypeBreedAgeKept Where?Time in Your CareSpayed/Neutered?If no, why not?Are your current pets current on vaccinations? You will need to provide record of this in order to adopt a pet*Please provide the name and phone number of your veterinarian*Are you financially able and willing to provide annual check-ups, vaccinations, and any medical care necessary for the pet?* Yes No If you have a dog, is it permitted to run loose?* Yes No What precautions would you take to properly introduce a new cat into your home?*What will you do if the cat does not get along with your presents pet?*If a behavioral problem arises, what steps will you take to work on it?*Are you planning to declaw the cat?* Yes No Have you ever adopted a pet from a rescue/shelter/animal control agency?* Yes No Have you ever had an adoption application rejected to adopt an animal from a rescue/shelter/animal control agency* Yes No If yes, please explain*Why do you want to adopt a rescue cat?*Are you familiar with our local animal control laws?* Yes No Do you agree to permit a visit to your home by appointment?* Yes No Agreement before signature* By signing below, I acknowledge that all information I provided on this form is true and correct. I understand that any misrepresentation of fact may result in the Rita B. Huff Humane Society refusing adoption privileges to me. The Rita B. Huff Humane Society reserves the right to decline adoption privileges for any reason due to information from the application or from written, verbal, or virtual conversations. If my request for adoption is approved and it is later found out by the Rita B. Huff Humane Society that the above information is not true or correct, the Rita B. Huff Humane Society reserves the right to remove the adopted cat from my home.*Signature*Date* MM slash DD slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ
