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Personal Information:
Full Name:
Spouse/Partner/Roommate:
Address
City/State/ZIP:
Phone Number:
Email:
Age:
Under 21
over 21
Occupation:
Hours:
Please list three personal references their relationship to you:
Referance #1
Name:
Phone#:
---Relationship---
Relitive
Co-worker
friend
Neighbor
Other
Address:
Referance #2
Name:
Phone#:
---Relationship---
Relitive
Co-worker
friend
Neighbor
Other
Address:
Referance #3
Name:
Phone#:
---Relationship---
Relitive
Co-worker
friend
Neighbor
Other
Address:
Your veterinarian:
Do you already have a veterinarian:
Yes
No
IF yes
Name of vet:
Vets address
City/State/ZIP:
Vets phone Number:
Your pets:
Do you Do you own any dogs:
Yes
No
If yes:
How many dogs:
---None---
1
2
3
4
5
6
7
8
9
10
More
Breed:
age:
Does your dog have any behavior problems:
Any dominance problems:
Do they get along with cats:
Yes
No
Not sure
How many cats do you have:
---None---
1
2
3
4
5
6
7
8
9
10
More
ages:
If none, have you owned a cat in the past fie years:
Yes
No
Any other pets:
Your children:
Do you have any children:
Yes
No
How many kids do you have:
---None---
1
2
3
4
5
6
7
8
9
10
More
ages:
have they had cats:
Yes
No
Was it successful:
Your home:
Number of adults:
--1--
2
3
4
5
6
More
Housing:
Rent
Own
Type of housing:
--Apartment--
Duplex
Townhouse
single home
Mobile home
Other
More
If you rent, do you have written permission from your landlord to have a cat:
Yes
No
Not yet
Landlords name:
Phone number:
Any community restrictions:
Yes
No
Not sure
Is anyone in your home allergic to cats:
Yes
No
Not sure
How will your foster cat spend its days:
--Indoors--
Outdoors
Crated
Basement
Garage
Porch
Yard
Cat house
Barn
Locked in a room
Other
Any additional comments:
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NEWBURGH SCATS
PO Box 7403
Newburgh, NY 12550