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 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 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 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
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Hours of Operation

Monday 11:30 - 5:00
Tuesday 11:30 - 5:00
Wednesday 11:30 - 5:00
Thursday 11:30 - 5:00
Friday 11:30 - 6:00
Saturday 11:30 - 5:00
Sunday CLOSED

Phone

(217) 223-8786
Fax: (217) 223-9471

Location

1705 N. 36th St.
Quincy, IL 62305

Mailing Address

PO Box 3173
Quincy, IL 62305

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Cat Application Form

Applicant Information

Household Information