JCHS Adoption Application

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Jefferson County
Humane Society

Phone:(785) 945-6600

Address:

15295 K4 Highway

Valley Falls, KS 66088

jfcountypets@gmail.com

Be Their Hero

Jefferson County Humane Society Adoption Application

Thank you for your interest in adopting a loving forever pet. Please take time to fill out our adoption application.

Animal species interested in?

Animal Name

Are you 18 or Older?

# of people in your household?

# of Adults?

# of Children?

Children's Ages

First name

Last name

Address

Apt.# or Letter

City, State, Zip Code

Home/Cell Phone #

Alternate Phone #

Occupation

Email

Do you Own or Rent?

Landlord Name or Company

Are you planing on moving in the next year?

Landlord/Rental Co. #

If yes, will your pet go with you?

Is anyone in your household have allergies to cats or dogs?

If yes, please explain

Who will supervise your children when interaction with your new pet?

Who will responsible for this pet??

In your absence, who will care for your pet?

Where will your pet(s) be kept during the day?

Why are you wanting to adopt this pet? Please click all that apply!

Best Friend

Companion

Emotional Support Animal

Companion for another pet

Hunting

Breeding

Fighting

Guard Dog

Proctection

A Gift for someone

Family Pet

Barn or Shop Pet

Mouser

Outdoors Pet

Indoors Pet

How many hours will this pet be home alone?

How will you confine your new pet to your property?

What type of grooming will you provide your pet?

Who will be responsible for socialization and training of this pet?

What behaviors will you not tolerate?

What type of activities do you envision doing with your pet?

What do you estimate the yearly expense of owning this pet?

Are there any free roaming cats or dogs in your neighborhood or nearby?

Please list all the animals that you have had in the past 5 years including the ones currently living in your home.

If you no longer have any of the listed animals, please explain what happend to them.

Are your current pets spayed or neutered?

Are your current pets vaccinated up to date?

Who is your current or preferred Veterinaran?

Veterinarian Phone #

Address

I knowledge and accept having a Veterinarian Background Check.

Yes

No

Have you ever applied to adopted from Jefferson County Humane Society?

Yes

No

Have you ever brought one of your pets to Jefferson County Humane Society?

Yes

No

If yes, please explain why?

Please understand it may take your new pet serveral weeks to adjust to your home... Are you prepared to allow this much time to adjust?

Yes

No

Yes, I understand if for any reason the pet won't work out for me or my family, I will return the animal to Jefferson County Humane Society.

Yes

No

*AGREEMENT NOT TO DECLAW CATS:

By adopting a cat from Jefferson County Humane Society, I acknowledge and agree to never declaw the cat or allow anyone else to do so.

Yes, I Agree to terms

No, I Don't agree terms

In the event that I violate this agreement, ownership of the cat will immediately be transferred back to JCHS. Furthermore, both parties agree that I will be responsible for paying JCHS liquidated damages of $500, along with all veterinary expenses related to the cat's declawing complications, as well as any attorney fees and court costs incurred in enforcing this agreement.a cat from Jefferson County Humane Society, I acknowledge and agree to never declaw the cat or allow anyone else to do so.

Yes, I Agree

No, I Don't Agree

By typing your name below you agree to the terms of JCHS Adoption Application.

Thank you for applying to adopt with us! We'll get back to you soon.

15295 K4 Highway, Valley Falls, Kansas 66088

785-945-6600

jfcountypets@gmail.com

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