Newnan-Coweta Humane Society and Shelter Rescue

Contact information: Applicant
First Name
Middle Initial
Last Name
Age
Occupation
Contact information: Co-applicant (Spouse orSignificant Other)
First Name
Middle Initial
Last Name
Age
Occupation
Street Address
City
County
State
ZIP
Home Phone
Work Phone
Email Address
Name of cat/kitten you are interested in adopting
List any general questions you would like to ask about this particular pet
Are you willing to allow a representative from NCHS to visit your home by appointment?	Yes No
Please check any of the following reason(s) for adopting this cat/kitten - you can select more than one.	Family pet Child's pet Companion Companion for other pet Gift Other - please specify
Please indicate where you live	apartment house condo/townhouse trailer/mobile home
Do you......	rent own
If you rent, do you have the landlord's permission to own a cat/kitten?	Yes No
What is the apartment complex name?
What is the landlord's phone number?
How much is the pet deposit?
How many times have you moved in the past 5 years?
If you move, will your pet go with you?	Yes No
Would you ever consider moving somewhere that doesn't allow your pet(s)?	Yes No
Do you foresee any major changes in your life in the next 15 years (average lifespan of a cat) such as marriage, childbirth, health problems due to age, going away to college?	Yes No
If yes, please explain
Do you or anyone in your household currently have any serious health problems?	Yes No
If yes, please describe
Can you provide a permanent home for this cat/kitten for10-15 years?	Yes No
What procedures will you use for litter box training?	Keep cat/kitten in one room with litter box Have several litter boxes in the house Outside only Other
If you selected "other", please describe
Number of adults in household
Relationship:	Spouse Roommate(s) Life Partner Other
If you selected "other", please specify
Will this cat/kitten be a surprise for any family member?	Yes No
If yes, who?
Do any family members have allergies?	Yes No
Do any children live in the house?	Yes No
If so, what are their ages?
Number, type and age of pets currently in household
Do any of your current or did any of your past pets live primarily outdoors?	Yes No
If yes, please describe pet
Were all previous pets spayed/neutered?	Yes No
Are all current pets spayed/neutered?	Yes No
What is your veterinarian's name and phone number?
What do you expect annual pet care (vet care, medication, vaccines, etc.) to cost yearly?
How many cats have you owned in the past?
If any, please describe what happened to each of them (put to sleep, run over, died of old age, sold, given away, ran away, etc.)
Who will be responsible for the daily care and training of your new cat/kitten?
How will you handle scratching or destructive behavior?
How do you plan to prevent fleas and ticks?
Are you aware of Frontline or Advantage?	Yes No
How many hours will the cat/kitten be home alone on a typical day?
Where does your current cat/kitten stay when home alone during the day?	Outside In the garage Inside in basement Inside free run of house Inside in one room of house Other
If you selected "other", please describe
Where will your new cat/kitten stay when home alone during the day?	Outside Inside in basement In the garage inside free run of the house inside in one room of the house Other
If you selected "other", please describe
Where do current pets sleep at night?	Inside in basement In the garage inside free run of the house inside in one room of the house In my bed Other
If you selected "other", please describe
Where will your new cat/kitten sleep at night?	Inside in basement In the garage inside free run of the house inside in one room of the house In my bed Other
If you selected "other", please describe
What percentage of time will the cat/kitten spend inside the house?
Have you ever had a serious behavior problem with a previous cat?	Yes No
If so, please describe
Have you always kept an ID tag (other than a rabies tag) bearing your phone number on your pets?	Yes No
Are you willing to keep a collar and ID tag on all your pets including a new cat at all times?	Yes No
What circumstances, in your mind, jusify giving up a cat?  Please check all that apply.	Moving New baby Not getting along with other pets Divorce Behavorial problems Children lost interest Too time consuming shedding Allergies Housebreaking problems Medical problems Aggressive behavior Other
If you selected "other", please explain
Have you ever given up a cat/kitten or had a cat/kitten for a brief period of time and it didn't work out?	Yes No
If yes, please explain the cirumstances and what happened to it?
Have you ever adopted a pet from NCHS or another humane society ?	Yes No
If yes, please explain
If you date or marry someone who does not like or want your pets, what would you do?
If your pet later develops a medical problem that becomes expensive, what would you do?	Find another home for him Pay whatever it takes Have him put to sleep Give him to a rescue group or shelter Other
If you selected "other", please explain
If your pet develops a frequent urination problem at the age of 12 and can't hold it when left alone, what would you do?	Have him put to sleep since he is older Babygate him in where flooring is not carpeted Give him to a rescue group or shelter Put in a cat door Other
If you selected "other", please explain
If you are considering a long-haired breed, how often would the cat be groomed?
Would he get haircuts?	Yes No
Would you do it yourself ?	Yes No