Date:
Name (Last, First):
Co-Applicant Name (Last, First):
Address:
City: State: Zip code:
Phone: Phone: email:
Birth Date: Relationship to Co-Applicant:
Home & Household Information
If you rent your home, you are required to provide verification that the landlord allows pets. If you live with your parents, you are considered a renter.
What type of Housing do you live in: . Single Family Home Townhome/Duplex Apartment Mobile Home Do you own or rent: . Own Rent
Please list each person who resides in your home (including children + ages, roomates, friends):
Please list the pets in the past 15 years that are you were financially responsible for. Please do not list childhood pets that your parents cared for:
Please complete below information regarding current pets
Have you had any additional pets in the last five years? Please list the species, age and reason you no longer own them. Lost, put to sleep (reason), given away (reason).
Veterinarian Name Veterinarian Phone:
Employment Information
Application Employer: Phone:
Position: Hours worked: Shift
Co-Application Employer: Phone:
Type of cats you want to help:
adult cat(s)
senior cat(s)
bottle fed kitten(s)
kitten(s)
mother cat and kittens
How many foster care cats are you willing to take (generally litter size is 2-5 kittens, although sometimes we do get singles. Its usually easier to take 2 kittens at one time as they entertain each other)
Foster Care Agreement
I understand the foster animals is the property of Paws and Purrs Humane Society, and will not sell, trade or dispose of the animal without consent of Paws and Purrs Humane Society. I will surrender the dog/cat to Paws and Purrs Humane Society immediately if requested to do so by a board member for any reason at anytime.
If the animal I foster is on medication, I will continue the medicate as directed. Paws and Purrs Humane Society pays for all medical expenses, and we will be in contact with you regarding meditcation and vaccinations.
If the foster animal becomes lost or runs away, the foster home must immediately contact Paws and Purrs Humane Society, the local police department, and animal control agency.
In the event of a medical emergency, the foster home will notify Paws and Purrs Humane Society as soon as possibe. Unapproved emergency vet visits to non-participating vets will not be reimbursed.
I understand that although Paws and Purrs Humane Society makes all efforts to screen animals for foster care placement, it makes no guarantee relating to the animals’ health, behavior or actions. I understand that I receive foster care animals at my own risk and can reject or return any animals for which Paws and Purrs Humane Society has asked me to provide care. I indemnify and hold Paws and Purrs Humane Society free and harmless from all liability arising out of any and all claims, demands, losses, damages, action, judgment of every kind and description which may occur to or be suffered by me, members of my household, my own animals or any third parties by reason of activities arising out of this agreement.
I release Paws and Purrs Humane Society from responsibility for any diseases that may be contracted by my own animal(s) from the foster animal. I agree that it is my responsibility to keep my own animals up to date on core vaccinations along with preventatives and will be responsible for any illnesses that may occur with their own pets.
By signing or typing your name below, the applicant and/or co/applicant understand and agree to all information provided to me in my application process. I understand that anyone interested in adopting my foster animal (including myself) must go through the adoption process, pay the adoption fee. Approval of adoption candidates and placement of animals is up to Paws and Purrs Humane Society.
Signature Required
Additional Comments / Notes: