CAT Adoption Application If you are interested in applying to adopt a CAT, please fill out the form below. Adoption Application: CAT Step 1 of 3 33% Which cat(s) are you applying for today?* PERSONAL INFORMATIONName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Cell PhoneWork NumberEmail* Date of Birth* MM slash DD slash YYYY Occupation* HOUSEHOLD INFORMATIONPlease list the members of your household (names and ages)*Who will be primarily responsible for the care of this animal?* Have you ever been charged with an animal related crime?* Yes No Please state your reason for wanting to adopt a new kitty:* Please list all your current pets and all the pets you have had in the past 5 years: (use the (+) symbol to add additional lines)*Pet’s NameSpeciesBreedAgeSexSpayed or Neutered? (Yes or No)If you no longer have this pet, where are they now? If your current pets are not up to date on vaccinations or spayed/neutered, please explain why:Have you ever had to give an animal away?* Yes No If yes, what were the circumstances? LIFESTYLE INFORMATIONAre you willing to work through any behavioral problems with your adopted animal?* Yes No I would NOT tolerate or would have difficulty managing the following (hold the Ctrl key to select multiple):*Not using the litter boxScratching furnitureWanting to go outsidePlay bitingNoneAre you willing to give the animal at least 6 weeks to adjust to its new environment?:* Yes No I would prefer a cat who will:* Live indoors Come and go independently Who is your veterinarian?* Veterinarian's PhoneDo you agree to take your adopted animal to a vet within 7 days of adoption?* Yes No Do you understand that your adopted animal may require additional veterinary care as a result of being exposed to shelter related illnesses (i.e. upper respiratory infection)?* Yes No Would you be willing to make a donation to help the other homeless animals of HSHC?* Yes No I understand that the falsification or omission of any of the above information will result in automatic refusal of adoption or confiscation of the adopted animal. I authorize HSHC to verify the validity of any information contained in this application. I hereby agree to release, discharge, indemnify and hold harmless the Humane Society of Harford County and any of its agents from any and all liabilities that may arise out of the handling by me and/or my party.Consent* I agree to the application policySignature* Date* MM slash DD slash YYYY CAPTCHA