Why do you want this particular cat?__________________________________

What will you do with your cat if you move?___________________________

How much do you expect to spend on your new cat in a year?____________

What will you do if your new pet scratches, dumps trash, etc.?

______________________________________________________________________

Please check all of the following that will apply to your new cat:
   Mouser:____     Companion:____    Barn Cat:____    Family Pet:____ 

If your cat sleeps on the bed and takes up most of the bed, do you ...
  (A) Make him get off the bed?
  (B) Go sleep somewhere else yourself?

Are you considering having your new cat declawed?_____________________

OTHER PET INFORMATION:

Are all adult members of your household in favor of adopting a cat?

        [  ]Yes      [  ]No      [  ]Don't know

Do you have other pets? Type and Number:______________________________

If your other pets are cats and/or dogs, are they spayed and/or 

  neutered?____  If no, why not?______________________________________

Are your other pets current on their vaccinations?____________________

Veterinarians name:___________________________  Phone:________________

What will you do if your newly adopted pet does not get along with 

  your other pets for a while?________________________________________

Do any of your pets have an infectious disease now, or have they in

  the recent past? ___________________________________________________

I certify that the information provided on this form is true and
correct.  I am also financially able to care for this animal.  I 
understand that proper food and veterinary care will be costly and am
able to meet these requirements.  I understand that in some cases, a
home check may be mandatory prior to your adoption.  I understand that
any false statements constitute grounds for confiscation and surrender
of the animal to the Humane Soc. of Park Co. I further understand and 
agree that the Humane Soc. of Park Co. may demand return of the animal 
for any violation of the terms of the adoption contract and agreement.

Signature:____________________________________  Date:_________________

        THE HUMANE SOCIETY OF PARK COUNTY RESERVES THE RIGHT
                       TO REFUSE ANY ADOPTION.

FOR STAFF ONLY:

Approved:____  Refused:____  Comments:________________________________