Adoption Application

Pre-Adopt Form

Note: All questions on this application are required in order for your application to be processed. Please answer all info on this form to help us find the best match for you.

About you:

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Animal you are interested in? *

About Your Home:

Do you own or rent your current home? *

Own Rent

How long have you lived at this current address *

Are you planning to move? *

Yes No Possibly

If yes or possibly, when? *

If you rent your home, does your lease allow pets? *

Yes No Not Sure Do not rent

Restrictions (e.g., breed, weight, landlord’s ok) *

Landlord's Name *

First

Last

landlord's Phone Number *

NOTE: If you live in a Condo/co-op, or your house is part of a homeowners` association, prior to adoption, you will need to provide a copy of the bylaws, rules and regulations of such association stating that there are no restrictions regarding owning a cat. If there is a limit on the number of pets you are allowed, please note that on the copy of the bylaws.

What is your household activity level? *

Quiet as a Library Grand Central Station Somewhere in between

Rate your comfort level with pets: *

First-time owner Have had 1 or 2 Experienced

Do you have children living at home? *

Yes No

If so, what are their ages? *

Do any children come to visit regularly? *

Yes No Occasionally

List all the people who will be living with the new pet? (Please list names, ages, and relationship.) *

*NOTE: Children in the home should accompany you if you are planning to adopt.

Who will the new pet be for? *

Myself My Family Other

If Other, Please explain *

Who will be the primary caregiver? *

Myself My Family Other

If Other, Please explain *

Is anyone living in your home allergic to cats or dogs? *

Yes, cats Yes, dogs No Not Sure

About Your Employment:

Where are you employed? *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Work Hours *

Phone Number *

If less than 1 year, please state how long at your previous job? *

References:

(Other than family)

Name *

First

Last

Phone Number *

Email *

Relationship *

Name *

First

Last

Phone Number *

Email *

Relationship *

Name *

First

Last

Phone Number *

Email *

Relationship *

About The Pet(s) You Would Like To Adopt:

Will the cat stay indoors at all times? *

Yes No Other

If Other, Please Explain *

Where will the cat spend the day? *

Loose Indoors Crate Basement

Where will the cat spend the night? *

Loose Indoors Crate Basement

On average, how many hours will the cat spend WITHOUT human company each day? *

About Your Other Pet(s)

(Tell us about the pets you currently own and owned in the past )

Do you Currently own any pets? *

Yes No

Pet Name, Breed/ Type of Pet, Age & Gender? *

Are all current pets spayed/ neutered? *

Yes No Other

If Other, Please explain. *

Do you still have all current pets listed above? *

Yes No Other

If Other, Please explain. *

About Your Veterinarian:

Note: If you currently own a pet or have owned a pet in the last 10 years, your vet`s name is required to process your application. If you cannot supply a vet reference, please give a reason why.

Do you have a regular Veterinarian? *

Yes No

How long have you been with this Vet? *

Reason as to why I can NOT supply a vet reference: *

Clinic Name *

Address *

Phone Number *

Name on the account? *

Please Read and Answer Each Item:

Do you understand that Helping Paws of Southern Minnesota requires all current pets to be spayed/neutered? *

Yes No

Do you agree to license and give regular vet care to this cat? *

Yes No

I understand that pets sometimes need veterinary care, including visits for common problems such as colds, diarrhea, or parasites, and that all veterinary expenses will be my financial responsibility. *

Yes No

Do you agree to contact Helping Paws of Southern Minnesota if you no longer can keep this cat? *

Yes No

You are 18 years of age or older *

Yes No

Are you willing to allow a Helping Paws representative visit your home upon appointment? *

Yes No

General Adoption Requirements:

Please Read all of the following and Sign below:

If you have a current pet, they MUST be up to date on vaccinations AND spayed/neutered.
If you currently own a pet or have owned a pet in the last 10 years, your vet's name and contact is required.
Maintaining vet records is part of responsible pet ownership. Full vaccine history, and spay/neuter status for all pets owned in the last 10 years is a requirement to adopt.
You must be 18 years or older to apply to adopt.
Applications must be filled out completely. If the application is not completely filled out, we will not be able to process it.
Animals will not be adopted to any college students living in a dorm.
Animals may not be adopted out as "gifts" for someone unless, all family members are aware of the adoption, and meet the animal before the adoption takes place. The application should be filled out by that said family.
If renting, approval from the landlord is required to keep the pet on the premises.
All applicants must be willing to receive a home inspection and meet and greet prior to adoption. (all family members and their pets must be present).
If you adopt and cannot keep the pet for any reason, you MUST return the animal to Helping Paws of Southern Minnesota.

*WE RESERVE THE RIGHT, IN OUR SOLE DISCRETION, TO REFUSE AN APPLICATION FOR ANY REASON WHATSOEVER.

As a 501(C)3) non-profit organization Helping Paws of Southern Minnesota has an adoption fee in order to help them cover expenses. All the above information I have given is true and completed. Should an unfixed cat be placed with me, it is my sole responsibility to make arrangements for that pet to be spayed/neutered by an agreed upon veterinarian on a day agreed upon by myself and Helping Paws of Southern Minnesota and provide proof to Helping Paws of Southern Minnesota of said procedure. This cat will reside in my home as a pet. I will provide it with adequate food, water, shelter, affection, and medical care. I understand that it is my responsibility to evaluate the cat for myself before agreeing to adopt it. All animals at Helping Paws of Southern Minnesota undergo a general evaluation from a licensed veterinarian; this is not a full work up and is not to be constituted as a bill of clean health. I am in full agreement with these terms of adoption. Helping Paws of Southern Minnesota shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, causes of action, fines, suites, demands, judgments of any nature whatsoever arising from the cat being placed in your home. Summiting this form constitutes your permission for us to check references and gives Helping Paws of Southern Minnesota authorization to investigate and review all information provided for truth and accuracy for the purpose of this application.

Signature is required below!

By typing your name below it will act as a signature *

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