19th WCC Foster Application

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Contact Number*

Area CodePhone Number

Who will take primary responsibility for the pet?*

Employer/Occupation*

List the Names and ages of all member of your household or anyone that visits your home on a regular basis. *

Are all members of your household in agreement regarding fostering?*

YesNo

Maximum number of hours per day that the pet will left alone.*

Is anyone in your household allergic to cats?*

YesNo

If yes, how do you plan on managing this?

Are you moving within the next 12 months?*

YesNo

Do you own or rent?*

OwnRent

If you rent, please provide the name and phone number of your landlord. 19th Ward will contact them to verify their pet policy.

Are there currently other animals living in your home?*

YesNo

If yes, List the names, species, breed, gender and ages of all the pets currently residing in your home.

Are any current cats residing in your home combo tested for feline leukemia and feline AIDS?

YESNOSome

Are your pets currently up to date on Vaccinations?

YesNoSome

Are your pets Spayed or Neutered?

YesNoNot YetSome not All

Do you agree to a member our staff visiting your home?*

YesNo

Do you agree to keep foster cats indoors at all times and to follow 19th Ward's recommendations regarding socializing your foster cat?*

YesNo

Interested applicants will be screened by 19th WCC and with your input, will be approved or denied by the19th WCC Adoption Coordinator. Do you acknowledge and understand that although your input will be a valuable tool in this process, the Adoption Coordinator will make the final decision regarding adoption candidates?*

YesNo

By signing via electronicly I agree that the information that I have provided in this application is complete and correct. I understand that any false information I have provided will invalidate this and any future applications. I further declare that I am financially and physically able to care for a animal. I submit that if a Home Check reveals falsification or misrepresentation of any facts on my part, 19th WCC reserves the right to remove the foster animal from my premises. I release 19th WCC from any liabilities I may incur while the foster animal is in my care including any injury to myself or anyone who comes in contact with the foster pet. Furthermore, I acknowledge 19th WCC has legal guardianship of the foster animal and may remove the animal from my home at their discretion.

Signature

Date