Name:
Address:
City:
State: AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MO MS MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Postal Code:
Country:
Daytime Phone:
Evening Phone:
Cell Phone:

Email:

Best time to reach you Morning Afternoon Evening

Description of current residence: Apartment Condominium Townhome Trailer Single Family Residence
How long have you lived at your present address? years.
Select one? Own or Rent

If renting, please provide landlord's contact information.
Landlord Name:
Landlord Address:
Landlord City: Landlord State: AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MO MS MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Landlord Postal Code:
Landlord Daytime Phone:
Landlord Evening Phone:
Landlord Email:
Occupation of household members:
Employer's Name:
Employer's Address:
City State AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MO MS MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Postal Code:

Please list names and ages of all people who will be living with the cat:

How did you hear about FSSR?
What breed cat would you like and why?
 
Will this be your first cat of this breed? Yes   No
 
Have you owned other cats before?  Yes   No
If yes, list breed, type(s): 
  
        

List other pets you currently own:
(Please indicate breed, age, sex and whether they are 
spayed/neutered)
 

Please list any characteristics your current pets have that
FSSR should be aware of:
 
        

Who will be responsible for the care and expenses of this pet (i.e. feed, 
train, exercise, groom, etc.)?   
 

How long are you willing to give your cat to adjust to his new home?   
 

Bad kitty habits I can't live with are:
 

Have you or a household family member ever received citations
for the violation of Federal, State or Municipal animal codes or been charged with
animal abuse? YesNo

Are the pets currently in your home up to date with their shots?   YesNo 

Are you aware of the annual routine vaccinations 
recommended for the health and protection of your cat?   YesNo
            

Current Vet:
  Name:    
  Address: 
  City:     State:  ALAKAZARCACOCTDEDCFLIDILINIAKSKYLAMEMDMAMIMNMOMSMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
  Postal Code: 
  Phone:   
        

 Is someone home during the day?
  Yes  No

Work hours?  
        

Please describe your exercise plan for your cat:
 
        

Please describe plans for care of your cat while away (i.e. vacation):
        

References:

Please provide the names, addresses, and phone numbers for two
people who are not relatives and do not reside in your household.

PLEASE NOTIFY YOUR REFERENCES AFTER SUBMITTING THIS FORM
THAT WE WILL BE CONTACTING THEM

 Reference #1:
        

 Reference #2:
        

Please tell us anything else you would like us to know about the cat 
you are looking for: 
 

We reserve the right to refuse or deny any application.