Foster Application form

Full Name*

First NameLast Name

Are you over age 18?*

YesNo

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Do you live in a:*

How long have you lived here?*

Do you:*

OwnRentLive with ParentsOther

Please indicate landlord contact information*

Is someone home all day ?

YesNo

Where will the cat be kept when no one is home?

Are there children at home?*

YesNo

What are the ages?*

Is anyone in the household allergic to cats?*

YesNo

Is shedding a problem?*

YesNo

Would you agree to a home visit as part of your application process?*

YesNo

Please list all the pets you currently have:*

Have they been spayed or neutered?*

YesNo

What is the reason for not been spayed or neutered?

Do your pets go outside?*

YesNo

Are they on a leash?*

YesNo

Have your cats been tested for FeLV/FIV?*

YesNoNot Applicable

What were the results?*

List all the pets you have had in the recent past and what happened to each.

List any pets you adopted from CatNIP before (names, dates, ages).

Have you ever surrendered a pet?*

YesNo

What was the reason?*

Have you ever been in violation of any animal laws?*

YesNo

Please explain *

Employer:

Name of your Veterinarian:

Phone Number of your Veterinarian:

Area CodePhone Number

Please list two personal references (no relatives) with names and phone numbers.

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Phone Number

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Phone Number

Area CodePhone Number

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I certify that the above information is correct, and I understand that the information will be verified.

Please allow several days for processing.

A CatNIP volunteer will contact you to acknowledge receipt of your application. We do not guarantee the fostering arrangement until we have reviewed your application and checked all references. If you have no current veterinary reference, a CatNIP volunteer will arrange a time to meet you in your home. The application process will take additional time if a home visit is needed.

Date

MonthDayYear

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Your name*