Cat Application Form

Please fill out this questionnaire. It is designed to help find a compatible cat with your lifestyle. It is our ultimate goal to match the right cat with the right home.

Printable PDF Version available if you prefer.

Name of Cat You Wish to Adopt

Applicant Name

Address

City

State

County

Phone

Email Address

Yes, I want to join your mailing list Yes, I want to receive information from Science Diet.

Landlord's Name

Landlord's Phone Number

Mobile Home Park Name

Mobile Home Park Phone Number

Do they permit pets?

Yes No

How Long Have You Lived at this Address?

Please List the Pets in your Home

Are all of your Pets Spayed or Neutered?

Yes No N/A

Are Your Animals Seen Yearly by a Veterinarian?

Yes No N/A

Veterinarian’s Name

Veterinarian’s Phone

Where will this cat spend most of it’s time?

Indoors Outdoors

Who is going to be the primary caregiver of this cat?

How many people are in your household?

What are their ages?

What are the working hours of the adults in your household

Where will this cat stay while you are at work?

Do you provide routine parasite control?

Yes No

Do you have anyone in your home that is allergic to cats? □

Yes No

Have you ever de-clawed a cat?

Yes No

Have you ever surrendered a cat to a shelter?

Yes No

If you are a multiple cat household, do you understand that multiple litter boxes need to be used?

Yes No

Do you have plans for your pets if you are not able to care for them in the future?

Yes No

Can you afford yearly veterinary care?

Yes No

I give the Humane Society of Westmoreland County permission to investigate all names and officials listed in this application. I understand that returning a cat for readoption is harmful to the well being of the animal. I, therefore, declare that all statements are truthful, and I will work to the best of my ability to meet all challenges.

Please Consider Supporting Us

Donate Today or Learn More about Other Ways to Give