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2. If you are interested in a specific cat, please put name below.
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Email:*
16. Are you at least 18 years old?*

    1. Yes
    2. No
18. You will be required to show a form of ID at time of adoption.
20. Do you own, rent, or live with someone on the property in which you reside?

    1. Own
    2. Rent
    3. Live With
22. If you rent or live with someone, do we have permission to contact them?

    1. Yes
    2. No
24. Landlord/Property Owner’s Name or Management Company
26. Landlord/Property Owner Phone Number
28. If you were to move, what are your plans for the care of your animal?
30. How many adults live at your residence?
31. How many children live at your residence?
32. Ages of children:
34. Is the pet a gift?

    1. Yes
    2. No
35. If yes, who is it for?
39. Please list below any current animals in your household:
41. PET #1
43. Pet Name
44. Male/Female

    1. Male
    2. Female
45. Cat/Dog

    1. Cat
    2. Dog
46. Other - Please Specify
48. Breed
49. Age
50. Spayed/Neutered

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

    1. Yes
    2. No
53. Where did your pet come from?
55. Who is listed as owner for the pet?
57. PET #2
59. Pet Name
60. Male/Female

    1. Male
    2. Female
61. Cat/Dog

    1. Cat
    2. Dog
62. Other - Please Specify
64. Breed
65. Age
66. Spayed/Neutered

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

    1. Yes
    2. No
69. Where did your pet come from?
71. Who is listed as owner for the pet?
73. PET #3
75. Pet Name
76. Male/Female

    1. Male
    2. Female
77. Cat/Dog

    1. Cat
    2. Dog
78. Other - Please Specify
80. Breed
81. Age
82. Spayed/Neutered

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

    1. Yes
    2. No
85. Where did your pet come from?
87. Who is listed as owner for the pet?
89. PET #4
91. Pet Name
92. Male/Female

    1. Male
    2. Female
93. Cat/Dog

    1. Cat
    2. Dog
94. Other - Please Specify
96. Breed
97. Age
98. Spayed/Neutered

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

    1. Yes
    2. No
101. Where did your pet come from?
103. Who is listed as owner for the pet?
105. PET #5
107. Pet Name
108. Male/Female

     1. Male
     2. Female
109. Cat/Dog

     1. Cat
     2. Dog
110. Other - Please Specify
112. Breed
113. Age
114. Spayed/Neutered

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

     1. Yes
     2. No
117. Where did your pet come from?
119. Who is listed as owner for the pet?
121. Please use the space below for any additional information regarding current animals in your household:
125. Veterinarian you currently use, or plan on using.*
127. Veterinarian phone number*
131. Have you ever surrendered your pet to a shelter before? *

     1. Yes
     2. No
133. If yes, please explain:
135. Have you ever given away or sold your pet before?*

     1. Yes
     2. No
137. If yes, please explain:
139. Have you ever lost a pet due to being strayed, stolen, hit by car, disease, or old age? Check all that apply.

     1. Old Age
     2. Medical Condition, Illness, or Disease
     3. Stolen
     4. Hit By Car
     5. Ran Away
     6. Other (please specify in space below)
141. If other, please explain.
145. Are you looking to adopt a cat that is declawed?*

     1. Front Declawed
     2. Not Declawed
     3. No Preference
146. Are your current cats declawed?
148. Do you have plans to declaw the cat you are adopting?*

     1. Yes
     2. No
     3. Maybe
150. Will this cat be an indoor or outdoor cat?*

     1. Indoor
     2. Outdoor
     3. Both
151. If you answered indoor, will the pet go outside at any time?

     1. Yes
     2. No
152. If yes, please explain:
154. Are you willing to adopt a special needs cat?

     1. Yes
     2. No
     3. Unsure
156. What reasons would cause you to return your cat?*

     1. None
     2. Biting or scratching
     3. Excessive meowing
     4. Litter box issues
     5. Other behavior issues (explain below)
     6. Allergies
158. Please explain the reason(s) you would return your cat if needed.
162. Have you adopted an animal from us before?

     1. Yes
     2. No
163. If yes, when?
165. Do you still have the animal that you adopted from us?

     1. Yes
     2. No
166. If no, why not?
168. Bringing a new pet into the home can take several days to weeks for an animal to feel comfortable in their new home. Are you willing to take the time needed? *

     1. Yes
     2. No
     3. Unsure
170. If no, or unsure, please explain below:
172. Do you understand the cost associated with owning a pet?*

     1. Yes
     2. No
173. Do you understand that by adopting this cat, it is a commitment for the life or health of the cat?*

     1. Yes
     2. No
175. Comments you would like to provide regarding your application:
179. Please read and initial the following and then sign to finish this application:
181. By submitting this application for adoption, I certify that the information I have given is true and everyone in my household is supportive of this adoption. I understand without exception, failure to give honest answers or failure to answer all questions could result in a delay or denial of this adoption. I authorize that the questions above may be used in reviewing my application. I understand that for any reason, as the adopter, it is my responsibility to follow the city/county/state ordinances in which I live in, regarding animal welfare and the care of my animal(s). If the animal that I am adopting, is involved in an altercation or bite incident, it is not the responsibility of this shelter. I understand and agree that if I am unable to care for my adopted pet or my living arrangements were to change where I am unable to keep it where I reside, I will contact Story County Animal Shelter to discuss the return of my animal.*

     Please initial below statement, confirming you have read through completely.

183. 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.
187. *PLEASE SIGN BELOW, I HAVE ANSWERED EVERYTHING COMPLETELY AND TRUTHFULLY AND I HAVE READ AND UNDERSTAND ALL OF THE ABOVE INFORMATION*
189. Your Signature
190. Date
     Date
192. 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!
194. 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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196. 1. Receive an email copy of this form.
197. Email address

     This field is not part of the form submission.

198. Submit Submit and Print

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