Application – Siskiyou Humane Society

Name

First

Last

Phone

Email

Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you have a different mailing address?

Yes

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Occupation

Where will the cat live with you? (check all that apply)

Please explain:

Do you ______ your home?

Rent
Own
Other

Please explain:

Do you have a written lease or agreement allowing pets?

Yes
No

Are there any restrictions on type, species, size or breed of pets you may have?

Please provide your landlord's name and contact information:

List any individuals that will be living in the household with the pet. Please include age and relationship to each person listed:

List any pets currently living in the household. Include the gender of the animal, the age of the animal and if they are currently spayed or neutered:

Are you aware the yearly vaccinations and routine preventative vet care typically costs between $80 - $200 per year?

Yes
No

Who is your Veterinarian?

How will you transport your pet home, to the vet, etc?

Have you ever been convicted of a crime that involved an animal(s)?

Yes
No

Have you ever had a pet euthanized?

Yes
No

Please explain:

Have you ever turned your dog or cat into a shelter?

Yes
No

Please Explain:

Please indicate the reason for adopting your pet: (check all that apply)

Please explain:

Does your home have a yard?

Yes
No
Other

Please explain:

Typical time away from home during the work week:

Please Explain:

If you are gone during the day, is someone else home?

Yes
No

Is that person willing and able to be responsible for looking after the cat?

Yes
No
Maybe

Where will your pet be kept during the day?

Indoors only
Outdoors only
In and out
Other

Please Explain:

Where will your pet be kept during the night?

Indoors only
Outdoors only
In and out
Other

Please Explain:

Would you object to an authorized representative of the SHS inspecting the animal and the premises where the animal is kept?

Yes
No

Would you like to join our mailing list?

Yes
No

How did you hear about us?

Please explain:

By typing my full name below, I am certifying that all the above information is true and accurate. I also understand that a giving false information on this application is grounds for denying my application.

ADOPTION CENTER: OPEN MONDAY - SUNDAY 12:30-4:00pm

ADOPTION CENTER: OPEN MONDAY - SUNDAY 12:30-4:00pm

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OUR PETS

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CAT ADOPTION APPLICATION