Name:
Address:
Email address:
Phone number(s):
Occupation/Employer
Phone Number
Landlord Name/
Phone Number
Own or Rent?
Number of children &
ages in household:
Names of all adults in
household:
Does anyone in household have
allergies?
Why do you want to
adopt a cat from us?
How many pets have you owned
as an adult?
Have you ever had to give up a
pet? If so, why & what happened
to the pet?
List the pets you have owned in the past 5 years, their type/breed,
spay/neuter status, age, where kept, how long you had them,
what happened to them and if you still have them.
Name & number of
your vet(s)
Do you agree to take your pet to the vet for its
annual vaccinations & exam?
How much do you estimate it will cost to
care for your cat for one year (food, vet bills,
etc.)?
Have you ever adopted from a Humane Society before?
 If yes, explain:
Are you willing to allow a NHS representative to visit
your home by appointment to approve your application
prior to adoption?  If no, please give reason.
If you must move in the future, what will you do with
your pets?
Do you agree to contact NHS if you are no longer able to keep your adopted cat?
Rescued cats need time to adjust to a new home.  Are you willing to give your new pet time to insure
proper adjustment (at least three weeks in many cases)?
IIf no, how much time will you
give the cat to adjust?
Who will have primary
responsibility for your cat's care?
What would be unacceptable behavior in your home for you
to want to give up the cat?
Where will the cat be kept in the daytime, i.e., in home, basement,
outbuilding, etc?
At night?
If the cat will be an outside cat, what type of shelter will it have?
Do you plan to let your cat exercise outdoors? Y/N Explain:
What type of food do you plan to feed your cat? (brand, dry/moist)
How will you transport your cat?
Additional comments:
CATS CAN LIVE 18 YEARS OR MORE.  ARE YOU PREPARED TO TAKE RESPONSIBILITY
FOR YOUR NEW CAT'S ENTIRE LIFE???
If you have no veterinary references, please list 3
personal references with contact numbers:
The applicant hereby grants the Humane Society permission to confirm any information provided in this application with any
appropriate third party source, including landlord, veterinarian, etc. The information obtained will be held in confidence and
used only by the Humane Society for purposes of this adoption.  I certify that all of the above information is true and complete
and I understand that if any false information, ommissions or misprepresentations are discovered, my application may be
rejected.  I also understand that this adoption application is sole property of the Northwoods Humane Society.  It is specifically
understood that NHS reserves the right to deny an adoption application at its own discretion. By submitting this form
electronically, it is understood that the applicant has read and agreed to these terms and conditions.