Name*:
Home Phone*:
Cell Phone:
Cat or Kitten applying for by name:
Cat or Kitten applying for by C or K #:
Address*
Apt.#
City*:
State*:	AK AL AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code*:
Employer:
Work Phone:
Email Address:
Best number to call you weekdays?	Home Work Cell

How did you hear about us?	Friend Web Newspaper Humane Society Drive-By Other
If Other chosen, please explain:
Would you like to find out more about volunteering, fostering, or socializing animals? Yes No
Have you ever had to turn an animal into a shelter before?	Yes No
Have you ever applied to adopt an animal from the Humane Society of Forsyth County?* (Must choose one)	Yes No
Have you ever adopted an animal from the Humane Society of Forsyth County?* (Must choose one)	Yes No
If yes, who did you adopt?
Would you agree to a home visit from a Humane Society Volunteer as a condition of adoption?*(Must choose one)   Yes No
What's this about a home inspection?

Why do you want a cat?*:	Family Pet/Companion Child Gift Mouser Companion for another animal Other
If Other chosen, please  explain: *
If gift, who will be the recipient?
Will it be indoors, outdoors, or both?*	Indoors Outdoors Both
Where will he or she live, i.e., basement, garage, house?**
What percentage of time will the cat spend:	Outside? *  Inside? *
How much time will this cat be alone (without human or other animal companionship)	Hours: Days a week:
Under what circumstances will you declaw your cat? Choose all that apply:
Scratching children/people
Scratching furniture
Scratching carpet/rugs
Climbing things in the house
Other pet is declawed and cannot defend itself against one not declawed
I do not believe in declawing
Other reasons why you would consider declawing:
Are all your current pets up to date on vaccines?	Yes No Some Are Does Not Apply, this is a gift Does Not Apply, this is my first animal Do Not Know
Are current pets spayed or neutered?	Yes No Some Are Does Not Apply, this is my first animal Do Not Know
If not, please explain?
On Flea Preventative?	Yes No Some Are Does Not Apply, this is a gift Does Not Apply, this is my first animal Do Not Know
If so, what kind?
Please list all pets your family has owned in the past 5 years, including where they are now, Doctor that animal was seen by including Vet's phone number.
Do you give Humane Society of Forsyth County permission to contact vet? *
Pet 1: No other animals Cat Dog Bird Other
Where are they now?	Does not apply Still in current household Returned to original owner/shelter Deceased Ran Away Stolen Other
If other, please explain:
Veterinarian Clinic/Doctor:
Contact Information - phone:
Pet 2: No other animals Cat Dog Bird Other
Where are they now?	Does not apply Still in current household Returned to original owner/shelter Deceased Ran Away Stolen Other
If other, please explain:
Veterinarian Clinic/Doctor:
Contact Information - phone:
Pet 3: No other animals Cat Dog Bird Other
Where are they now?	Does not apply Still in current household Returned to original owner/shelter Deceased Ran Away Stolen Other
If other, please explain:
Veterinarian Clinic/Doctor:
Contact Information - phone:
More than 3? Yes No
If yes, you can provide Humane Society of Forsyth County (HSFC) more details later.
How much would you expect to spend yearly on routine vet visits, health care, and food for this pet?* $
(Expenditures include, annual vet checks and shots, healthy food, dental care, heartworm and flea preventative.)
A cat can live well over 10 years and requires a major commitment of time, finances, and emotion. Why do you feel you can make this commitment at this time?*
Do you agree, for the pets safety, to keep an ID tag on this animal at all times?* Yes No Not Sure

If you know a member of the Humane Society of Forsyth County you would like us to contact for a personal reference, please use the space below.

Reference Name:
Relationship:	Friend Relative Neighbor Co-worker Other
If Other, please explain:
Reference Phone Number:
Reference Email:

If there is an animal care professional or other rescue organization you would like us to contact for a personal reference, please use the space below.

Reference Name:
Relationship:	Animal Care Professional Other Rescue Group
If Other Rescue, please give name of the rescue group:
Reference Phone Number:
Reference Email: