Newnan-Coweta Humane Society and Shelter Rescue

First name:
Last name:
Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Cell Phone:
Email address:
Fax Number:
How did you hear about us?:
Do you have a home computer?:	Yes No
Do you have a printer?:	Yes No
Best time to contact:
Emergency Contact Name and Number:
Please list any other adults living in the household:
Please list names and ages of any children who either live with you or visit you on a regular basis (include any grandchildren or other relatives) :
Please list names,ages, spay/neuter status, species (dog, cat, etc.) and breed of ALL pets in your household :
Are there any relative's pets frequently in your home?:	Yes No
If so, please provide all info requested above, for those pets :
Do you take care of friends' pets in your home while they are on vacation?:	Yes No
If so, please provide all info requested above, for those pets :
How does your cat(s) react to other cats (friendly, growls, hisses, etc) :
Are ALL pets in your household current on ALL recommended and/or required vaccinations?:	Yes No
Please list dates of last vaccinations (Rabies FVRCP, etc) :
Name, address and phone of current Veterinarian (require 3-year history, so list more than one if necessary).  Please include the name the vet records are listed under if different from applicant's name :
Have you ever had a cat diagnosed with FIV or Feline Leukemia?:	Yes No
If yes, please explain :
Do You:	Own Rent
Do you reside in:	House Townhouse Apartment Duplex Other
If you rent, do you have the landlord's permission to have a pet?:	Yes No
Landlord's name, address and phone number :
If yes, please explain?:
Are you employed:	Full-Time Part-Time Both Other
Is anyone home during the day?:	Yes No
If so, who?:
If yes, where will the cat be during the day?:
Where will the cat be kept at night?:
Does anyone in the household have allergies to cats?:	Yes No
Do you have any de-clawed cats in your household?:	Yes No
Do you have a kitty door?:	Yes No
Have you had experience in introducing a new cat into your household?:	Yes No
If yes, please describe how this was accomplished :
Are you willing to supervise any children around your foster cat at ALL times?:	Yes No
Please describe the type(s) of foster cats you are willing to have in your home i.e. cat, kitten, female, male, senior? :
How many cats are you willing to foster at one time? :
Is there a preferred activity level for a cat you would want to foster? :
Please describe your level of experience as a cat owner and provide an honest assessment of you abilities to recognize and deal with any problem behaviors a foster cat might exhibit such as scratching and litterbox training, etc. :
Describe any medical treatment or special care you have given cats (trim nails, clean ears, administer medication, etc) :
Have you ever been cited by Animal Control?:	Yes No
If so, what state, county, when and for what reason? :
Have you ever fostered a cat before?:	Yes No
If yes, please explain? :
If a member of a breed club or another rescue, please list :
I/we acknowledge that all the information provided is true and correct and that I/we have answered all questions truthfully.  Submission of application does not guarantee placement of a foster cat through Newnan-Coweta Humane Society and Shelter Rescue.Request information on:

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