Cat Application Form

Welcome! Thank you for choosing to adopt a pet from Kiya Koda Humane Society! We are excited to help you find the right companion for your family. The questions on this application are not a test. They simply help us learn more about you, your household, and your lifestyle so we can help make the best possible match.

Adopting a pet is a lifelong commitment.

We strongly encourage all members of your household, including any other pets, to meet the animal prior to adoption.

Kiya Koda Requirements:

  • You must be at least 18 years of age
  • All adults living in your household must be aware of the adoption and agree that the pet may live in the home
  • You must provide a valid form of identification showing your current address, or other acceptable proof of current address
  • Animals adopted from Kiya Koda Humane Society are adopted as family pets and may not be adopted for consumption, research, or any other purpose prohibited by our adoption policies
  • We require spaying of all females and neutering of all males
  • If you are unable to keep your adopted pet for any reason, the animal must be returned to Kiya Koda Humane Society. Adoption fees are non-refundable
  • Kiya Koda is not responsible for any illnesses, injuries, or veterinary expenses that may occur after the animal has been adopted
  • Kiya Koda is not responsible for any damage or injury caused by an adopted animal to any person, animal, or property after adoption
  • Sterilization of adopted animals is required pursuant to Iowa Code Section 162.20. A person who fails to satisfy the sterilization requirements may be guilty of a simple misdemeanor

Kiya Koda reserves the right to refuse any pet adoption.

Pet Name *

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Section I — Adopter Information

General Information
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Address
Emergency Contact (Outside of Your Household)

1. Where do you live:

2. Do you:

3. Have you ever adopted a pet from Kiya Koda?

4. Have you ever been refused adoption of a pet from Kiya Koda or any other shelter?

If yes, why?

5. Have you ever been involved with an animal control department?

If yes, what were the circumstances?

Section II — Household Details

1. How many adults live in your household?

How many children?

2. What are the children's ages (if applicable)?

Any allergies?

3. What will be this pet's role in the family? Please check all that apply.

4. Who will be responsible for feeding this pet?

Training?

5A. Have you had any pets in the past 5 years?

5B. Are there any pets in the home now?

If so, please fill out this chart:

Breed Age Spayed/Neutered? Vaccinated? Action

Add

Delete

6. Who will be this pet's veterinarian?

7. If you move in the future, what will you do with this pet and your other pets?

8. Does anyone in your household have pet allergies?

If yes, please explain:

Section III — Role in the Family

All pets have requirements that can sometimes be easily overlooked. The purpose of this section is not to test you, but to get you thinking about your responsibilities as a pet owner. After you complete this section, you may have some questions about caring for your new pet. We will be happy to answer them.

1. Do you know that in the first year, regular preventative care may cost $500?

2. Did you know that in the first year, pet food and pet supplies may cost $1000+?

3. About how many hours per day will this pet be alone in the home without human companionship?

How many days per week?

4. Where will this pet be kept during the day?

At night?

5. (Outside Cats) A shelter is an insulated structure that has bedding inside. Shelter keeps pets warm in the winter, cool in the summer and gives them room to stand up, stretch out, and lie down comfortably. Will your new pet have shelter?

It may take three months or more for this new pet to adjust to your home (depending on the household). Are you willing to give ample time for adjustment?

Section IV — Application Agreement