Approved: Yes / No

Date Received

Time Received

Initials

4205 NW 6th ST ∙ Gainesville, FL 32609

Ph: (352) 373-5855 Fax: (352) 373-1087 www.alachuahumane.org

Adoption Application

Adopter Name:

Address: Apt:

City: State: Zip: County:

How long have you lived at this address: __________ mo/yr Own Rent Condo Mobile Home

Home Ph: Cell: Work Ph:

Email:

Alternate Contact Name: Relationship:

Alternate Contact Phone:

(Please Print Clearly)

Thank You for considering adopting your family pet from the Alachua County Humane Society. Because the

average life of an animal is between 10 and 15 years, ACHS wants to insure high compatibility between animal and

adopter. Please take a few minutes to answer all the questions below.

THE CAT(s):

What is the primary reason you are adopting (check all that apply):

Mouser House Pet Companion Gift Company for another pet Other: _____

Our cat will live: Indoors Only Indoors/Outdoors Primarily Outdoors

What type of cat would you consider ideal for your family (check all that apply): Short Hair Medium Hair

Long Hair Young Middle Aged Senior Male Female Affectionate/Social

Independent Lap Cat Playful No preference(s)

It is most important to me that my cat: _____________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

After your adoption, you will be required to take your new cat to the veterinarian within one week for a thorough

examination. Are you prepared for this expense in addition to any costs related to daily care, such as food, water,

litter, etc.? Yes No

OUR HOUSEHOLD:

Who will be the primary caretaker for this cat? ______________________________________________________

How would you describe your cat experience:

This will be my first cat I’ve had one or two I’m experienced and knowledgeable

I share my household with (check all that apply): Other Adults Children Other Animals

If yes to Adults/Children: How many? _______________ Ages? _____________________

Current Animal(s) Living In the Household

List all animals you currently own. Include each pet’s name, breed, sex and age. Circle yes or no regarding

sterilization and vaccination. Indicate the length of time you have owned each animal in years and months.

Animal Name Breed Sex Age Spay/Neuter Vaccinations Heartworm How long have you

M/Fe yrs circle one Current Prevention owned this animal

Current

1. _____ ____ ______ ______ Yes No Yes No Yes No Indoor/Outdoor

2. ______ ____ ______ ______ Yes No Yes No Yes No Indoor/Outdoor

3. ______ ____ ______ ______ Yes No Yes No Yes No Indoor/Outdoor

4. ______ ____ ______ ______ Yes No Yes No Yes No Indoor/Outdoor ______________

Please provide contact information for your primary care veterinarian: Name:___________________ Office Phone:_______________

Does anyone in your household have pet related allergies? Yes No

My home is: Grand Central Station Has some activity Quiet/Serene

I am away from home: More than 8 hours per day 4-8 hours per day Less than 4 hours per day Varies daily

If you checked “Varies daily”, please explain: ___________________________________________________________________________

__________________________________________________________________________________________________________________________________________

Are you planning to have this cat de-clawed: Yes No Are any of your other cats de-clawed: Yes No

Are you aware that cats can get heartworms? Yes No

Are you aware that both cats and dogs are now governed by Alachua County’s leash laws? Yes No

Cats are not allowed to free roam. If you are intending to allow your cat(s) outdoors, please describe how the

cat(s) will be contained to comply with this law.

_______

I certify that I am 18 years of age and verify that the information I have provided is true and correct. I

understand that if any information provided by me is false or inaccurate, I will not be eligible to adopt from the

Alachua County Humane Society (ACHS) now or at any time in the future. I also permit ACHS to use any

photograph(s) taken of me with the pet I have adopted in their newsletter, brochures, website or any other

media. By signing this application I give permission to the ACHS to verify the information provided and I give

permission to the persons and businesses listed to release the information to the ACHS. I am aware that ACHS

has the right to deny my application.

Signature Date