Northwoods Humane Society
PO Box 82 Hayward, WI 54843
Cat Pre-Adoption Application
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Approved___
Denied___
PF___
Cat________________
Notified Y / N
Date______________
To help us help you and the cat you want to adopt be suited to each other, we would like you to fill out this application so that you and your
future pet may live happily ever after. .
ABOUT YOU AND YOUR HOUSEHOLD:
Name_________________________________________Home Phone:__________________________Day Phone:______________________
Address:______________________________________________________City:_______________________ State:_____ Zip:__________
How long at this address?_________Physical Address_____________________________City___________State_________Zip__________
Adopter Occupation________________________________________________________________Work Phone_______________________
Do you own or rent?_________________ Landlord's Name__________________________________________ Phone__________________
Name of other adults living in your household_____________________________________________________________________________
How many children?______________________ Their ages__________________________________________________________________
Do any of the above people have allergies?________________________________________________________________________________
Why do you want to adopt a cat from us?________________________________________________________________________________
YOUR EXPERIENCE WITH PETS
How many pets have you owned as an adult?_________Have you ever had to give up a pet? Y/N Why?_____________________________
What happened to the pet?____________________________________________________________________________________________
PETS YOU HAVE OWNED IN THE LAST FIVE YEARS:
Name Dog/Cat/Other M/F Spay/Neuter Breed Where Kept How Long Owned Still Own
M/F Y/N
M/F Y/N
M/F Y/N
M/F Y/N
M/F Y/N
M/F Y/N
If you don't have the above pets anymore, please explain what happened to them._________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Who is your veterinary clinic?_______________________________________________Phone #_____________________________________
Do you agree to take your pet to your Veterinarian annually for full vaccination and exam? Y / N
How much do you estimate it will cost to care for your cat for one year (food, vet bills, license, etc.)?_________________________________
Have you ever adopted from a Humane Society before? Y / N: Explain__________________________________________________________
Are you willing to allow a NHS representative to visit your home by appointment to approve your application prior to adoption? Y/N
If no, 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? Y/N
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)? Y/N
If 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?____________________________________________
___________________________________________________________________________________________________________________
CARE OF YOUR NEW CAT
Where will your cat be kept in the daytime? In home / basement / Outside / Outbuilding / Other
At night? In home / basement / Outside / Outbuilding / Other
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
Name ____________________________________________________ Phone #_________________________
Name____________________________________________________ Phone #_________________________
Name____________________________________________________ Phone #_________________________
......................................................................................................................................................................................................................................
The undersigned 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.
Signature Date