First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

What is your age?*

Please provide 3 character references and phone numbers (non-family members) and please let them know we may be contacting them.:

Please provide the name and phone number of your current and/or previous veterinarian or clinic to contact for a reference (please call you veterinarian and let them know we will be calling): *

Do you live in a*
Choose one: House Condo Mobile home Apartment Other

Do you own or rent?*
Choose one: Rent Own

If rent, provide name and phone number of landlord to obtain permission for this animal to live in your home:

List any pets you own or have owned in the past five years, their species, and their ages. If this is your first pet, please note below.*

If you have cats, have they been tested for Feline Leukemia and Feline Immunodeficiency Virus (FIV) If so, what were the results?*

Please list all people living in your household, including yourself and any children. List everyone's names and ages.*

If there are any children in the household, have they previously interacted with animals?
Choose one: Yes No

Does anyone in your home have allergies to animals or have asthma? *
Choose one: Yes No Not sure

Have you adopted from an animal welfare group before?*
Choose one: Yes No

If yes, what group?

Are you willing to have a representative from Kizzy's Place come to see where the pet will be living*
Choose one: Yes No

I am interested in fostering (choose all that apply):
Choose all that apply: Adult cats Special needs cats Bottle babies Young weaned kittens (4-8 weeks old) Older kittens (over 8 weeks old) Kittens than need additional socialization

I intend to make every effort to keep my foster animals until they are adopted or placed at offsite adoption center. I understand that if my circumstances change I will remain responsible for my foster animals until alternative placement is found*
Choose one: Yes No

I will treat my foster animals with kindness, provide them with age-appropriate food, will give them access to clean water and clean litterboxes at all times, and will not use aversive training methods with them. I will take them to veterinary appointments promptly.*
Choose one: Yes No

Are you willing to take your foster animals to adoption events?
Choose one: Yes No

Do you own a car or otherwise have access to reliable transportation in order to take your foster animals to veterinary appointments and adoption events?*
Choose one: Yes No