Which cat are you interested in?

Name

Driver's License Number

Date of Birth (MM/DD/YYYY)

Address --Select--   0   1   2   3   4   5   6   7   8   9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Address 2

City

State --Select--   0   1   2   3   4   5   6   7   8   9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Zip

Phone

Email

Employer

How long have you been at your current job?

Do you live in a(n) --Select-- House Townhouse Apartment/Condo Other

Your home is: --Select-- Owned by you or your spouse/life partner Owned by someone else living within the house Rented directly from the owner or management company Rented as part of a group of roommates Other

If renting, is your name on the lease? --Select-- Yes No N/A

If renting, do you have your landlord's permission to have a cat? --Select-- Yes No N/A

Landlords Name and Phone:

N/A if not applicable

Who shares your household? Spouse/ Life Partner Roommate(s) Boyfriend/Girlfriend Other

Are there children in the home? --Select-- Yes No

Please list everyone in the household including name, relationship, and age

Does anyone in your household have an allergy to cats that you are aware of? --Select-- Yes No

Where will your cat stay? Indoors Only Outdoors Only Indoor/ Outdoor

If outdoors, how long after adoption would you start allowing your cat to go out?

Share your reasons for wanting a cat Family Pet Gift for someone else Mouser Companion Child's companion Companion for another pet Other

(check all that apply)

Do you currently have pets? --Select-- Yes No

If yes, please list the following for each pet: Species, Breed, Gender, Age, Spayed or Neutered, If not, why.

How do you feel your current pets will adjust to a new cat in the house?

N/A if not applicable

It is in our contract that any cat adopted from TCHS will not be declawed. Please check below that you are agreeing to not declaw this cat. I agree

Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new cat? --Select-- Yes No

Other concerns:

Who is your veterinarian (name and phone)?

If you move, what will you do with your cat?

Additional comments about why you would like to adopt this particular cat:

Is there anything else you would like to share with us? Any "Other" responses that you want to explain?

Acknowledgement I understand that a home visit may be required prior to final placement.

Acknowledgement I understand that a home visit does not guarantee placement.

Acknowledgement I agree to bring my own carrier at the time of the adoption pick up. I acknowledge that without said carrier, I will not be able to pick up my cat/s that day.

By signing this contract I am certifying that the information given on this adoption application is true and correct and that I recognize that any misrepresentation of the facts submitted herein may result in losing the privilege of adopting or keeping an adopted animal. I understand that Trempealeau County Humane Society has the right to deny my request to adopt an animal, and I authorize investigation of all statements in this application. I understand that this application is the property of Trempealeau County Humane Society. Disclosure and Release Clause: I, the undersigned, do hereby declare that I am aware: 1. The actions of animals are often unpredictable; 2. Animals should be closely supervised when they are with children; 3. An animal's behavior may change after it leaves the shelter and accustoms itself to a home or other different environment; 4. Trempealeau County Humane Society makes no claims or representations as to the temperament, health or mental disposition of any animal put up for adoption; 5. Trempealeau County Humane Society is not held liable for conditions arising from the adoption of an animal; 6. THE ADOPTING FAMILY DOES HEREBY RELEASE, DISCHARGE AND HOLD HARMLESS TREMPEALEAU COUNTY HUMANE SOCIETY AND ANY PERSON, FIRM OR CORPORATION CHARGED OR CHARGEABLE WITH LIABILITY TOGETHER WITH THEIR HEIRS, ADMINISTRATORS, EXECUTORS, SUCCESSORS AND ASSIGNS FROM ANY AND ALL CLAIMS, DAMAGES, COSTS, EXPENSES, LOSS OF SERVICES, ACTIONS OR CAUSES OF ACTION, WHETHER KNOWN OR UNKNOWN, BELONGING TO THE FAMILY DUE TO ANY ACTION OR OCCURRENCE ARISING OUT OF OR IN CONNECTION WITH THE ADOPTION OF A PET FROM TREMPEALEAU COUNTY HUMANE SOCIETY 7. I agree to abide by all city and county animal control ordinances, specifically any leash laws to prevent the animal from roaming and becoming a nuisance animal; 8. It is expressly understood that such animal is NOT to be sold, traded, or given away for any purpose. It is not to be abandoned. IF I CANNOT PROVIDE FOR THE ANIMAL ANY LONGER, I WILL RETURN IT TO TREMPEALEAU COUNTY HUMANE SOCIETY; 9. Adopter agrees that, without liability, TREMPEALEAU COUNTY HUMANE SOCIETY may investigate the adopter’s home and the conditions under which the animal is being kept, and may take possession of the animal, if in the opinion of TREMPEALEAU COUNTY HUMANE SOCIETY, it is receiving less than adequate care, is being improperly housed or handled, or if any other condition of this contract is being or has been violated. In the event the adopter fails or refuses to return such an animal upon demand, the adopter hereby agrees to pay reasonable attorney’s fees in the event an attorney is consulted or if suit is brought for the return of the animal; 10. The adopter acknowledges reading and understanding all policies within this contract and accepts this animal as a pet and companion, and willfully accepts the terms outlines within this legally binding agreement. By signing your name below, you hereby agree to all above terms

Type your name to sign this application

Date Signed

*I have read and agree to the Terms and Conditions