Welcome - Humane Society of South Central Michigan

? Feline Adoption ProfileDate: FORMTEXT ?????Time: FORMTEXT ?????Please be advised by filling out this application you are not obligated to adopt. Completing this profile is not a guarantee that you will be allowed to adopt a pet at this time. Name: FORMTEXT ????? FORMTEXT ?????Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????Zip: FORMTEXT ?????Email: FORMTEXT ?????Phone #1: FORMTEXT ?????Phone #2: FORMTEXT ?????Your Age: FORMCHECKBOX 20 or under FORMCHECKBOX 21 – 35 FORMCHECKBOX 36 – 55 FORMCHECKBOX 56+Length of time living at address:________________Do you: FORMCHECKBOX Own FORMCHECKBOX Rent Apartment FORMCHECKBOX Rent House FORMCHECKBOX Live with Parents FORMCHECKBOX Other: FORMTEXT ?????Do you foresee any changes in your current living arrangement (i.e. moving, house guest, vacations,?etc.)? FORMCHECKBOX NO FORMCHECKBOX YESIf YES, please explain: _________________________________________________________Landlord Name and Phone: FORMTEXT ?????Known rental restrictions/conditions: FORMCHECKBOX Front Declaw FORMCHECKBOX Back Declaw FORMCHECKBOX Other: FORMTEXT ?????Are you: FORMCHECKBOX Employed FORMCHECKBOX Unemployed FORMCHECKBOX Retired FORMCHECKBOX Student Name of Employer:___________________________Is anyone in your household allergic to cats or dogs? FORMCHECKBOX Yes FORMCHECKBOX No How many people live in your house?_______Are there children in your home? FORMCHECKBOX Yes FORMCHECKBOX No Ages of Children:___________________________________Co-Applicant: FORMTEXT ?????Relationship: FORMTEXT ?????Email: FORMTEXT ?????Phone: FORMTEXT ?????Employer: FORMTEXT ?????Age: FORMCHECKBOX 18 or under FORMCHECKBOX 19 – 20 FORMCHECKBOX 21 – 54 FORMCHECKBOX 55+ FORMCHECKBOX Employed FORMCHECKBOX Unemployed FORMCHECKBOX Retired FORMCHECKBOX Student Cat Experience: FORMCHECKBOX First-time owner FORMCHECKBOX Have had one or two cats FORMCHECKBOX Cat expert!Time Away from Home: FORMCHECKBOX Home all day FORMCHECKBOX Home part-time FORMCHECKBOX Away 7-10 hours daily FORMCHECKBOX Away longer than 10 hoursOur Cat Will: FORMCHECKBOX Live indoors only FORMCHECKBOX Go indoors/outdoors FORMCHECKBOX Live outdoors onlyHome Atmosphere: FORMCHECKBOX Busy! Lots of Activity/Noise FORMCHECKBOX Moderate. Some visitors FORMCHECKBOX Quiet and SereneName(s) of cats you are interested in adopting from our facility: FORMTEXT ?????How much do you anticipate spending yearly to provide food and medical care for your new cat? FORMCHECKBOX Less than $100 FORMCHECKBOX $100 - $200 FORMCHECKBOX $200 - $300 FORMCHECKBOX $300 - $400 FORMCHECKBOX $400 - $500 FORMCHECKBOX $500+Where will your cat stay when left alone? FORMTEXT ?????How will you provide entertainment for your cat? FORMCHECKBOX Toys FORMCHECKBOX Play with my cat FORMCHECKBOX Play with other pet (dog/cat) FORMCHECKBOX Other: FORMTEXT ?????Name of current and/or previous veterinarian & phone number:Current Pets in HomeType of animal:______________________ Name:_____________________________ Age: _________ FORMCHECKBOX Male FORMCHECKBOX FemaleSpayed/Neutered FORMCHECKBOX Yes FORMCHECKBOX NoKept: FORMCHECKBOX Inside FORMCHECKBOX Outside FORMCHECKBOX Both How long have you had this pet? _______Type of animal: _____________________ Name: ____________________________Age: _________ FORMCHECKBOX Male FORMCHECKBOX FemaleSpayed/Neutered FORMCHECKBOX Yes FORMCHECKBOX NoKept: FORMCHECKBOX Inside FORMCHECKBOX Outside FORMCHECKBOX Both How long have you had this pet? _______ Type of animal:______________________ Name:_____________________________ Age: _________ FORMCHECKBOX Male FORMCHECKBOX FemaleSpayed/Neutered FORMCHECKBOX Yes FORMCHECKBOX NoKept: FORMCHECKBOX Inside FORMCHECKBOX Outside FORMCHECKBOX Both How long have you had this pet? _______Please list any additional pets that have been in your care the past eight years (include all exotic pets):Name/Type of AnimalBreedYears OwnedSpayed/ NeuteredInside/OutsideWhere is pet now?(if deceased, when?) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????If you have adopted an animal from HSSCM previously, please list the animal name and date: __________________Have you ever had to find a new home for one of your pets, or surrender a pet to a shelter or animal control? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please explain: FORMTEXT ?????What will you do with your cat when you go on vacation? FORMTEXT ?????If you have to move, what would you do with your cat? FORMTEXT ?????In the case of personal illness or your death, who will provide care for your cat? FORMTEXT ?????Under what circumstances would you need to return your cat to HSSCM? FORMTEXT ?????Are any of your current or previous cats declawed? FORMCHECKBOX Yes FORMCHECKBOX NoDo you plan to declaw your new cat? FORMCHECKBOX Yes FORMCHECKBOX NoIf you marked yes to declawing, please explain reasons why: FORMCHECKBOX Protect furniture FORMCHECKBOX Protect wood fixtures/flooring FORMCHECKBOX Young children FORMCHECKBOX Other (please explain in space provided): How much time will you give your cat to adjust to your home? FORMTEXT ?????What type of cat best describes what you are looking for in your future companion (check all that apply): FORMCHECKBOX Playful (with toys) FORMCHECKBOX Playful (rough-house) FORMCHECKBOX Rambunctious FORMCHECKBOX Calm FORMCHECKBOX Attention-junkie FORMCHECKBOX Regal FORMCHECKBOX Lap-seeker FORMCHECKBOX Independent FORMCHECKBOX Vocal FORMCHECKBOX Reserved/quiet FORMCHECKBOX Loving/Cuddly FORMCHECKBOX Sassy FORMCHECKBOX Explorer FORMCHECKBOX Tolerant FORMCHECKBOX DurableDo you understand that the Humane Society of South Central Michigan does not guarantee the health of its animals and that additional medical care at your personal expense may be necessary? FORMCHECKBOX Yes FORMCHECKBOX NoPersonal References (non-family members)Name: FORMTEXT ?????Phone: FORMTEXT ?????Relationship: FORMTEXT ?????Name: FORMTEXT ?????Phone: FORMTEXT ?????Relationship: FORMTEXT ?????OverI have seriously considered all aspects of owning a pet and I am aware of the time and money involved. I am prepared to make a commitment to the pet being adopted for its lifetime. HSSCM has the right and responsibility to assist me in selecting a pet that is well suited to me and my lifestyle. I certify that the answers on this profile are accurate and understand that false information will result in nullifying the adoption. I understand that this questionnaire remains the property of the Humane Society.SignatureDate ................
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