Feline Guardianship Form Step 1 of 6 16% *Thank you for taking the responsible step to enroll your beloved pet in Yavapai Humane Society’s Pet Guardianship Program. Cats can’t talk, so they can’t tell us where or with whom they would like to live. To ensure that their home is a safe, happy & appropriate place for your cat to live, we need you to fill out this form in as much detail as possible. Detail & honest information from you is crucial to our placement process, so please take the time to fill in this profile with care & accuracy. Undesirable behaviors & medical issues do not necessarily create problems, however, not disclosing those problems definitely does. Inaccurate or incomplete responses can undermine the safety & happiness of both your cat & the new adopting family. If there are any questions that are unclear or that you are uncomfortable responding to for any reason, please ask to speak directly to one of our helpful staff about the issue. First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Cat's Name*Vaccinated within the past year* Yes No Which veterinary facility?Cat's Age*Sex* Male neutered Male un-neutered Female neutered Female un-neutered Is your cat declawed* Yes No Not Sure Paws Declawed Include Front Back Both How long have you owned this cat?*Where did you obtain this cat?* Yavapai Humane Society Other shelter Breeder Pet store Friend Found Rescue group Newspaper Other Please explain otherTo your knowledge, how many homes has this cat had before living with you?*Please list the ages and sexes of the people this cat has lived with Would you recommend placing this cat in a home with children under 10 years of age?* Yes No Not Sure Why or why not?If this cat lived with children under 10 years of age, how did they interact?*(Check all that apply) Actively avoided child Growled / Hissed at child Child could pet the cat Ignored each other Played together Gentle / Affectionate Unknown Other Other - Please explain below:Please tell us what other animals your cat has lived with*Check all that apply Male cat(s) un-neutered Male cat(s) neutered Female cat(s) un-spayed Female cat(s) spayed Dogs Never lived with other animals Other Other - Please explain belowHow does this cat behave with other cats in your home or outside of your home?*Check all that apply Bullies Frightened Friendly / Playful Never around other cats Growls / Hisses Shy Curious Ignores Unknown Other Other - Please explain belowWould you recommend placing this cat in a home with other cats?* Yes No Not Sure Why or why not?How does this cat interact with dogs?*Check all that apply Chases Curious Friendly Growls / Hisses Frightened Ignores Gentle Never around dogs Unknown Other Other - Please explain below Is your cat litter box trained?* Yes No Not Sure What brand of litter does your cat prefer?Has the cat ever inappropriately eliminated? Yes No Not Sure If yes where? On the floor On the wall (spray) On the furniture Other Other - Please explain belowWhere does the cat reside?* Inside only Inside / Outside Outside only Barn cat What toys does he/she like to play with?* How many hours a day is your cat left alone?* More than 10 hours 8-10 hours 5-8 hours 0-4 hours Never left alone Other Other - Please explain belowAre there any particular people or things that your cat appears to be afraid of?* Men Women Children Dogs Cats People in uniforms Strangers Vacuums / Brooms Cars / Trucks Water Thunderstorms Loud Noises None Other Other - Please explain belowWhat does your cat do that leads you to believe he/she is afraid?Has your cat everCheck all that apply Bitten Hissed Growled Scratched Other Other -Please explain belowWhat made them behave this way? Food Rough play Toys Strangers Children Adults Other Animals Other Other - Please explain belowDoes your cat have any current, previous or recurring medical or behavioral problems?Please describe in detailWhat medication is your cat currently taking?What part of your cats body does he/she not like touched?Check all that apply Feet Back Legs Head Tail Mouth Belly Other Other - Please explain belowHow does he/she respond?Check all that apply Snaps Growls Lunges Urinates / Defecates Struggles / Attempts to escape Cowers Other Other - Please explain belowWhat is the name of your veterinarian/veterinary clinic?*What brand and type of food have you been feeding your cat?*Please upload a photo or photos of your pet(s) Drop files here or I certify I have the authority to enroll the above described animal in the Pet Guardianship Program. Upon my death or incapacitation, I hereby relinquish all rights of ownership, in the above-described animal(s) in favor of Yavapai Humane Society, and I agree that the animal(s) may be placed up for adoption, transferred to another animal welfare organization or humanely euthanized at the sole discretion of Yavapai Humane Society. I authorize the transfer of my animal’s information (as listed above) to a new owner when this animal is placed up for adoption. The information on this form is to the best of my knowledge, accurate & complete. I understand that every effort will be made to place the animal in a foster home while it awaits adoption, but it may be housed temporarily in the YHS Adoption Center. I understand that YHS will attempt to place my animals in the same home but also understand the most important thing is to have them in a loving home, even if it means they are separated.Digital Signature First Last Date Date Format: MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.