Quincy Humane Society
Saving Pets and Their People Since 1880
Call:
(217) 223-8786
Home
Adopt
Our Available Pets
Adoption FAQs
Dog Adoption Application
Cat Adoption Application
Programs & Services
Spay / Neuter Clinic
Make a Spay/Neuter Appointment
Vaccination Clinic
How Can I Help?
Wish List
Donations
Volunteer
Foster Program
Ava’s Garden
Planned Giving
Events
The Fabulous FurBall
Tours & Birthday Parties
Mutt Strut
News / Resources
About Us
History
Resources / Links
Testimonials
Join Our Mailing List
Contact Us
Cat Application Form
Name of cats interested in:
*
Applicant Information
(Adult #1) Name:
*
First
Middle
Last
(Adult #1) Date of Birth
*
Date Format: MM slash DD slash YYYY
(Adult #2) Name
First
Middle
Last
(Adult #2) Date of Birth
Date Format: MM slash DD slash YYYY
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Home Phone
*
(Adult #1) Cell Phone
(Adult #2) Cell Phone
# of years at residence:
*
Prior Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Type of Property
*
House
Townhouse
Apartment
Condo
Mobile Home
Other
*If you are not the owner of your home, please provide the home owner's name and phone number
(Adult #1) Employer
Position
Phone
(Adult #2) Employer
Position
Phone
Household Information
# of adults in household
*
Relationship(s)
# of children in household
*
Age(s)
Is anyone allergic to animals?
*
Yes
No
If yes, what type of animal?
If you have to move in the future, what will you do with your pets?
*
Who in your household will be the pet’s primary caregiver?
*
What are your beliefs regarding spaying/neutering?
*
If yes, why?
Pet Ownership
Please list all dogs and cats you have owned as an adult (past and present):
Who is your Veterinarian?
Veterinarians Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
When was your current pet’s last visit to a Veterinarian?
Date Format: MM slash DD slash YYYY
Are all your pets up-to-date on vaccinations?
*
Yes
No
If no, why?
# of pets you have had as an adult:
*
Have you adopted from the Quincy Humane Society in the past?
*
Yes
No
If yes, where is the animal now?
Cat / Kitten Application
Describe your ideal pet
*
Why do you want to adopt?
*
What kind of pet are you looking for?
*
Indoor
Outdoor
Indoor / Outdoor
Where will the cat be when you're at home?
*
Where will the cat be when you're not home?
*
Where will the cat be when you're asleep?
*
How will you entertain/exercise your cat?
*
How often will you scoop the litter box?
Have you ever clipped a cat’s nails?
*
Will you de-claw your cat?
*
No
Yes (2 paw)
Yes (4 paw)
How will you introduce this cat to other animals in your household?
*
How much time are you prepared to allow for your new pet to adjust to your home?
*
Under what circumstances would you return this cat?
*
How many hours a day will your cat be alone?
*
Are you committed to providing a responsible home for your pet’s entire life? (Could be 18+ years)
*
Yes
No
Have you ever turn an animal into a shelter?
*
Yes
No
If yes, why?
Are you prepared to assume the financial responsibilities of providing a cat with adequate food, training, toys, routine and emergency medical care, etc? (Could $1,000+ per year)
*
Yes
No
Are you willing to sign a legal contract agreeing to pet owner responsibility?
Yes
No
By my signature, I certify that the above information is complete and correct and that I am at least 18 years of age. I realize that any misrepresentation of fact may result in my losing the privilege of adopting an animal. I understand that the Quincy Humane Society has the right to deny my request for adoption. I authorize verification of all statements on this application I including but not limited to prior vet medical history. I understand that this application is the property of the Quincy Humane Society who reserves the right to share this information with other shelters and rescue organizations.
Signature
*
Date
*
Date Format: MM slash DD slash YYYY
CAPTCHA
find your forever friend
Want to find your forever friend?
Click here.
Join Our Mailing List
Learning more about our shelter and our upcoming events, join our mailing list today!