Barn Cats

2. Barn Cat/Working Cat Registration Form

   Please complete ALL fields in this form. You will not be able to submit the form until ALL fields are completed.

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Email Address*
14. Phone Number*
16. Do you live at this location full time?*

    1. Yes
    2. No
17. How many barn cats/working cats are you interested in?

    1. 1
    2. 2
    3. 3

    1. 4
    2. Other
19. What kind of shelter would this cat(s) have?*

    1. Barn
    2. Warehouse

    1. Business
    2. Other
20. Is the shelter heated?

    1. Yes
    2. No
22. The majority of cats in our barn cat program do not enjoy human contact. Let us know if you have particular needs such as, age, gender, color, numbers of cats or friendliness. Please note these below.*
24. By checking "I Understand & Agree" for each item listed below, affixing my Electronic Signature and submitting this application, I acknowledge and agree to adhere to the following.
26. I am responsible for providing food, water and shelter for my colony.*

    1. I Understand & Agree
28. I recognize that the cat(s) are under socialized and not fitted for a home environment. *

    1. I Understand & Agree
30. I am responsible for finding a substitute caretaker to replace me temporarily or permanently on those occasions when I can no longer perform as the caretaker for my colony (i.e. should I go out of town on a trip, be temporarily disabled, or move away so that I am unable to continue my caretaking).*

    1. I Understand & Agree
32. Do you agree to trap and take the vet if they become ill or injured?*

    1. I Understand & Agree
34. By affixing your electronic signature below, you affirm that you are authorized to submit this application and all answers in this application are true and correct. You further accept the terms and conditions of set forth above.
36. Electronic Signature*
    Please type in your full legal name.
37. Today's Date*
    Today's Date
39. After you have completed all fields on this form, please click on Submit or Submit & Print (if you want to keep a printed copy). After you click on Submit or Submit & Print, you will be redirected to a submission confirmation page. If you are unable to submit, it is likely that you failed to complete a field on this form.
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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

* indicates a required field