Adoption Form - Cats - Pembina Valley Humane Society

Name of Cat Interested In*

Full Name*

Email Address*

Address*

(if rural, list both physical & mailing address)

City/Town/RM*

Province*

Postal Code*

Phone Number*

Alt Phone Number

Preferred Contact Method*

Phone

Best time of day to reach*

Are you 18 yrs of age or older?*

Yes

Full names of all adults who reside in the residence:*

List the ages of all children under 18 yrs:*

Does anyone in the home have allergies to pets?*

Yes

Did all household members participate in this decision?*

Yes

Why do you want to adopt?*

Family Pet

Barn Cat/Mouser

Gift

Other

Other*

Do you live in a:*

Other1*

Do you:*

Other2*

What qualities are important to you for your next cat?*

(example: calm, housetrained, affectionate, good with other cats, etc)

How many hours will the cat be alone per day?*

How many days per week will the cat be alone?*

Where will your cat be kept when home alone?*

Indoors

Outdoors

Barn

Garage

Where will the cat sleep at night?*

Indoors

Outdoors

If your cat will be kept mainly outdoors, please describe accommodations for the cat.*

How many pets have you had in the last 5 years?*

(Dogs, Cats, Other)

How many pets do you currently live with?*

(Please list age and breed of all animals in the home)

Are your pets spayed/neutered?*

Yes

If not, why?*

Which veterinary clinic would have past or present records?*

Which veterinary clinic will you take your new pet to?*

Have you ever had to return or re-home a pet? If so, why?*

A cat can live well over 10 years and requires a major amount of time, exercise, finances and emotional stimulation. Do you feel you can make that kind of long-term commitment at this time?*

Yes

Please check off all areas you would like to discuss with the shelter manager:*

Introducing new cat to other pets

Kids & Cats/Kittens

Nail Trimming/Declawing

Diet/Nutrition

Litter Training

Proper Socialization

Toys/Enrichment

Pet Identification

Other

Reference 1

*Only 1 reference can be a relative & that relative must not live with you. All references must be 18 years of age or older.*

**If references do not call back within 72 hours of initial contact we will move on to the next applicant**

Name*

Relationship*

Contact Phone #*

Email Address*

Best time of day to be reached*

Reference 2

Name*

Relationship*

Contact Phone #*

Email Address*

Best time of day to be reached*

Veterinarian

Name*

Contact Phone #

Landlord (if not applicable, enter N/A in following fields)

Name*

Contact Phone #*

Email Address*

Best time of day to be reached

I certify that the information given on this form is true and correct and I recognize that any misrepresentation of facts will result in my being unable to adopt a pet from PVHS. I understand that submission of this application does not guarantee adoption and that approval or denial of this application is at the sole discretion of PVHS.

This field is for validation purposes and should be left unchanged.

Adoption Form – Cats

Reference 1

Reference 2

Veterinarian

Landlord (if not applicable, enter N/A in following fields)