Feline (Cat) Adoption Application

Are you interested in adopting a particular cat?

Have you adopted a pet from us before? *

Please correct - Have you adopted a pet from us before?

Are you affiliated with The Worcester County Humane Society or do you know someone affiliated with us?

What type of cat are you looking for? *

Adult

Do you want a particular breed, color, or fur length?

Female

Kitten

Male

Senior

Special Needs: Behavioral

Special Needs: Medical

Please correct - What type of cat are you looking for?

What energy level are you looking for in a cat? *

High energy

Low energy

Medium energy

Please correct - What energy level are you looking for in a cat?

About Me and My Home

What type of home do you live in? *

Apartment

Condo

Duplex

House

Mobile

Other

Please correct - What type of home do you live in?

Do you rent or own your home? *

Own

Rent

Please correct - Do you rent or own your home?

Landlord's Name

Number of adults in your household: *

Please correct - Number of adults in your household:

Landlord's phone number

Number of children (under age 18) in your home *

Please correct - Number of children (under age 18) in your home

Ages

Are there any persons who regularly visit the home (grandchildren, family members, etc)? Explain and list visitor(s) ages below. *

Please correct - Are there any persons who regularly visit the home (grandchildren, family members, etc)? Explain and list visitor(s) ages below.

My Habits

What qualities and behaviors are you looking for in your new cat? (check all that apply) *

Affectionate

Cuddler/lap cat

Independent

Mellow/easy going

Mouser/outdoor cat

Quiet

Responsive

Talkative

Zippy/high energy

Please correct - What qualities and behaviors are you looking for in your new cat? (check all that apply)

When home alone, your cat will be: (check all that apply) *

Barn

Garage

In the house

Indoor/Outdoor freedom

Other, or comments:

Outdoors

Outdoors on a leash

Screened porch

Please correct - When home alone, your cat will be: (check all that apply)

Under what circumstances would you declaw? (check all that apply) *

Destruction of furniture

Landlord requirement

New baby

None

Other cat is declawed

Other, or comments:

Scratching people

Unsure

Veterinarian recommended

Please correct - Under what circumstances would you declaw? (check all that apply)

Are you aware of the potential side effects of declawing a cat? *

Yes

Please correct - Are you aware of the potential side effects of declawing a cat?

Which of the following would you like to know more about?

Litter box habits

Multiple cats

Newborn/toddlers with cats

Other:

Scratching furniture

Would you allow our representative to visit your home before the adoption is completed? *

Yes

Please correct - Would you allow our representative to visit your home before the adoption is completed?

Contact Info

First Name *

Please correct - First Name

Middle Name

Please correct - Middle Name

Last Name *

Please correct - Last Name

Date of Birth *

Please correct - Date of Birth

Home Phone *

Please correct - Home Phone

Cell Phone

Email *

Please correct - Email

Address *

Please correct - Address

City *

Please correct - City

State *

Please correct - State

Zip Code *

Please correct - Zip Code

Do you own or rent? *

Own

Please correct - Do you own or rent?

Rent

How long have you lived at the address? *

Please correct - How long have you lived at the address?

List previous address.

Are you *

Attending school

Homemaker

Other

Retired

Working

Please correct - Are you

Who has been your veterinarian?

Veterinarian's phone *

Please provide your Veterinarian's phone number

Veterinarian's address *

Please provide your Veterinarian's address

Agreed to terms * I agree.

Please correct - Agreed to terms

How did you hear? Facebook Fundraiser Other Website

What pets have you owned in the past?

Pets Name 1

Breed 1

Pet Age 1

Pet Gender 1

Spayed/Neutered 1

Still have this pet? 1

Pets Name 2

Breed 2

Pet Age 2

Pet Gender 2

Spayed/Neutered 2

Still have this pet? 2

Pets Name 3

Breed 3

Pet Age 3

Pet Gender 3

Spayed/Neutered 3

Still have this pet? 3

Pet Name 4

Breed 4

Pet Age 4

Pet Gender 4

Spayed/Neutered 4

Still have this pet? 4

Pet Name 5

Breed 5

Pet Age 5

Pet Gender 5

Spayed/Neutered 5

Still have this pet? 5

Please list 2 personal references (not related to you)*

Reference Name 1 *

Please correct - Reference Name 1

Reference Phone 1 *

Please correct - Reference Phone 1

Reference Name 2 *

Please correct - Reference Name 2

Reference Phone 2 *

Please correct - Reference Phone 2

Worcester County Humane Society | No Kill Shelter

My Preferences

About Me and My Home

My Habits

Contact Info

What pets have you owned in the past?

Please list 2 personal references (not related to you)*