Have you ever been charged with a crime involving violence against an animal or human?
Yes
No
Name
*
First Name
Last Name
I certify that I am 18 years or older
*
Yes
No
Email Address
*
Address (street, city, state, zip code)
*
Phone number
*
Best way to contact you
*
Email
Phone
Occupation
*
Employer
*
Type of home you live in
*
House
Condo/Townhouse
Apartment
Trailer home
If you selected trailer home, please provide contact information for the mobile home park office (include name and phone).
Do you rent or own your home?
*
Own
Rent
If you rent or are a roommate of the homeowner, provide the landlord or owner's name and phone number:
Do you have permission to have a cat?
*
Yes
No
Veterinary reference
*
Provide contact name and phone number.
Provide the name under which the veterinary records can be found.
*
Number of people living in the home (count yourself):
*
Number of people living in the home under the age of 18:
*
List the names, ages, and relationship to you of each individual under the age of 18 in your home:
*
Does anyone in the home have allergies?
*
Yes
No
If yes, describe how the allergies are being controlled.
Is everyone in the home in favor of fostering?
*
Yes
No
If no, provide the reason.
Do you currently have pets?
*
Yes
No
If yes, please list your pets:
Are your pets current on vaccinations?
*
Yes
No
If no, please explain:
Are your pets spayed or neutered?
*
Yes
No
If no, please explain:
Have you sold, given away, abandoned, or put to sleep a pet?
*
Yes
No
If yes, please explain:
Has a pet ever disappeared, been killed, or mistreated while in your care?
*
Yes
No
If yes, please explain:
Describe any and all conditions you would consider giving up a pet.
*
Where will the cat be left while no one is home?
*
Are you willing to work with the cat on issues it may have?
*
No
Yes
Are you willing to allow a Purrfect Pound Pals volunteer to do a home visit?
*
Yes
No
By checking this box, I certify that I have answered all of the above questions truthfully and to the best of my knowledge.
*
