Date: Name of cat desired: Color(s):

Applicant Information

City: State: Zip:
Telephone numbers: Home: Work: Cell:
E-mail Address: Date of Birth:
Are you presently:    Employed     Employer: Unemployed      Retired      Student
Number of People in Household: If children are in the household, please list ages:
Are you or any member of your family allergic to pets:       Yes             No

Co-Applicant Information

Name: Relationship:
Telephone numbers: Home: Work: Cell:
E-mail Address: Date of Birth:
Are you presently:    Employed     Employer: Unemployed      Retired      Student

General Information

Type of residence:               House               Apartment        Condo              Mobile Home                  Farm/Barn
If rental, are cats allowed?:                Yes    No
Complex name/address:
Manager/Landlord: Phone number:
Current housing location:                   City Limits        Outside City Limits
Type of street:             Very busy road        Slight traffic       Residential area      Country road Speed limit:
Where will cat live?        Inside only             Outside only    Mostly inside            Mostly outside
Where will the cat spend nights?      Inside                Outside
Will you allow the cat to run loose?                  Yes    No If Yes, where?
How many hours per day will the cat be alone? Where will the cat stay when left alone?
Describe the activity level in your home: Busy (visits by friends, meetings, children, parties at home)

Noisy (TV, stereo, machinery, tools, children playing, dogs barking)

Moderate (Normal comings and goings)

Quiet (homebodies, few guests)

Other (specify)

In the absence of the primary caregiver, who will care for the cat?
Under what circumstances would you return the cat to us?   New Job     Divorce     New Baby      Move     Illness                    Other – specify

Are you willing to take responsibility if this pet acquires an illness?      Yes          No

Are you willing and able to pay the veterinary costs of caring for your new pet?   Yes      No

Do you consider your cat a part of the family?  Yes            No Do you plan to declaw your cat?  Yes      No

How much time are you prepared to allow for your new pet to adjust to your home?

Pet Information

Have you had pets in the last five years?  Yes   No If yes, complete the following chart
Name of Pet; Type of Pet Years Owned Spayed/Neutered Inside/Outside Where is Pet Now?
Yes    No Inside    Outside
Yes    No Inside    Outside
Yes    No Inside    Outside
Yes    No Inside    Outside
Yes    No Inside    Outside
Current or past vet name of clinic: Phone:
Are you aware that a cat is a large and lifelong commitment?     Yes         No
How did you hear about  F.U.R.R.? Would you like to become a volunteer?  Yes  No

Personal References

# 1  Name: Relationship:
Phone: Best time to contact:
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