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2. Shelter number or name of barn cat you are interested in:
4. Name:
5. Home Phone #:
7. Address:
8. Cell Phone:
10. City/State/Zip
11. Email:
13. Are you at least 18 years old?

    1. Yes
    2. No
14. Do you own or rent the property in which you reside?

    1. Own
    2. Rent
    3. Live with someone who owns the home
16. If you do not own your residence, who is your landlord and what is their phone number?
20. Please list below any current animals in your household:
22. PET #1
24. Pet Name
25. Type/Breed
26. Age
27. Spayed/Neutered

    1. Spayed
    2. Neutered
29. Up to date on shots?

    1. Yes
    2. No
30. Where did you get the pet?
32. PET #2
34. Pet Name
35. Type/Breed
36. Age
37. Spayed/Neutered

    1. Spayed
    2. Neutered
39. Up to date on shots?

    1. Yes
    2. No
40. Where did you get the pet?
42. PET #3
44. Pet Name
45. Type/Breed
46. Age
47. Spayed/Neutered

    1. Spayed
    2. Neutered
49. Up to date on shots?

    1. Yes
    2. No
50. Where did you get the pet?
52. PET #4
54. Pet Name
55. Type/Breed
56. Age
57. Spayed/Neutered

    1. Spayed
    2. Neutered
59. Up to date on shots?

    1. Yes
    2. No
60. Where did you get the pet?
62. PET #5
64. Pet Name
65. Type/Breed
66. Age
67. Spayed/Neutered

    1. Spayed
    2. Neutered
69. Up to date on shots?

    1. Yes
    2. No
70. Where did you get the pet?
72. Please use the space below for any additional information regarding current animals in your household:
76. Current and/or previous veterinarian’s name (last 10 years) and phone number:
80. Are your pets listed under your name at the Veterinarian’s clinic?

    1. Yes
    2. No
81. If not, who’s name would they be listed under?
83. Why do you want a barn cat?
85. Since this will be an outdoor cat, what type of housing will be provided for it?
89. Barn cats must be securely confined for the first 2 weeks. Are you prepared to allow this much time?

    1. Yes
    2. No
93. Do you plan on having the cat vaccinated regularly?

    1. Yes
    2. No
95. If you move, will the cats be moved with you?

    1. Yes
    2. No
96. If no, why not?
98. Do you understand that by adopting this cat, it is a commitment for the life of the cat?

    1. Yes
    2. No
99. Do you understand that there are laws/ordinances in effect for each city/county/state that you live in regarding animal welfare, care and responsibilities for pet owners?

    1. Yes
    2. No
101. Do you understand that if for any reason this cat is involved in an altercation or bite incident that it is no responsibility of this shelter?

     1. Yes
     2. No
103. Comments you would like to provide regarding your application:
107. Please read and initial the following and then sign to finish this application:
109. Thank You for taking the time to fill out this application. A comprehensive questionnaire helps us in placing the right cat, in the right situation. By answering all of these questions with full disclosure, we believe your chances of success and happiness between you/your family and this cat will have maximum benefits.
111. By submitting this application for adoption, I certify that the information I have given is true. I understand failure to give honest answers could result in denial of this adoption. I authorize my veterinarian and landlord (if applicable) to release any information to Story County Animal Shelter that is pertinent to this application. I understand that without exception, failure to answer all questions asked on this application, may result in denial of adoption for this cat.
113. PLEASE ALLOW AT LEAST 2-3 BUSINESS DAYS FOR YOUR APPLICATION TO BE REVIEWED. THERE MAY BE SEVERAL APPLICATIONS FOR EACH ANIMAL. WE DO NOT ADOPT OUT ANIMALS ON A FIRST COME, FIRST SERVE BASIS. SUBMITTING AN APPLICATION IS THE FIRST STEP OF THE ADOPTION PROCESS, AND DOES NOT GUARANTEE APPROVAL FOR AN ANIMAL.
117. *PLEASE SIGN BELOW, I HAVE ANSWERED EVERYTHING COMPLETELY AND TRUTHFULLY AND I HAVE READ AND UNDERSTAND ALL OF THE ABOVE INFORMATION*
119. Your Signature
120. Date
     Date
122. Story County Animal Shelter/Animal Control, is dedicated to finding caring and responsible homes for their animals. All applicable ordinances and laws for Story County are observed and enforced by this department. Story County Animal Shelter appreciates your understanding and support!
124. THIS APPLICATION WILL REMAIN ON FILE FOR 90 DAYS.- AFTER THAT A NEW ONE MUST BE COMPLETED IF YOU ARE CONSIDERING ADOPTION AGAIN.
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126. 1. Receive an email copy of this form.
127. Email address

     This field is not part of the form submission.

128. Submit Submit and Print

* indicates a required field