First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone*

Name of primary caregiver *

Name of Spouse or other resident

Name of emergency contact*

Have you had pets before?
Choose one: Yes No

If you have had previous pets, please list the type of pet you have owned.

Did you use veterinary services with previous pets?
Choose all that apply: Yes No

Where were veterinary services performed if needed?

Age of Caregiver

Please list any health considerations (ie diabetic, wheelchair, on blood thinners, arthritis, etc)

Do you currently have any other pets?
Choose one: Yes No

If so, what type of pet do you have?

Please describe any attributes you would like to see in your foster cat.

Do you prefer a male or female cat ? (all are spayed/neutered)

Do you have a color or hair length preference?

Why do you want a cat?

How would a cat benefit from living with you?

Is there a relative or friend willing to assume care for the cat if the primary caregiver is unable?
Choose one: Yes No

What is the name, relationship and contact information for the person who could assume care for the cat if the primary caregiver is unable.

Do you agree to a scheduled home visits by a Sheltering Hands representative?
Choose one: Yes No

Do you agree to contact Sheltering Hands in case of an inability to continue care for the cat or in case of medical concerns for the cat in your care.
Choose one: Yes No