First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Cell Phone*

Alt Email*

How many people in your home are usually financial providers?

Is anyone in the home currently bringing in any income?

If no one is currently working in the household, is it due to Covid-19?

Are there any children currently living in the home full time?

How many children are currently living in the home?

What type of pets do you currently have? (Please select all boxes that apply)
Choose all that apply: Dog(s) Cat(s) Feral Colony

Please list what type of pets you have and how many of each (Examples are - I have 4 dogs, 2 cats... I have 1 feral colony... I have 2 cats and 1 feral colony)*

Are these your personal pets or are you fostering for an organization or are you a breeder, etc? Please select all boxes that apply.
Choose all that apply: These are my personal pets I am fostering for a rescue organization I am a breeder

Are your pets spayed or neutered?

If your pet is not spayed or neutered, please specify why not. *

If you have listed that you care for a feral cat colony, have the cats been through the Trap-Neuter-Return program and have all the cats been s/n, vaccinated, microchipped and eartipped?

If you listed that you have a feral cat colony, please list who your TNR Sponsor organization is*

If we were to provide you with pet food, would you be available for a contactless pickup on Saturday, April 18th between the hours of 10:00am and 2:00pm in the Humboldt Park community?

Email will be the primary method of communication from Shelter, so if you do not check email regularly, please tell us how to best get in touch with you.*

By submitting this application you agree and acknowledge the following: 1. To not sell, transfer, trade or barter any Donation or portion thereof in exchange for money, property or services or otherwise allow the items to enter commercial channels. 2. To release both Donor and Donor’s source(s) from any liability arising from the condition of Donation and further agrees to indemnify and hold harmless Donor and its source(s) against any and all damages, losses, claims, causes of action and suits of law or in equity or any obligation whatsoever arising out of or attributed to any action of in connection with Recipients receipt, handling or distribution of Donation. 3. That goods or services are provided on an "as is" and "as available" basis. Whiskers & Tails Rescue Foundation expressly disclaims all warranties of any kind, whether express or implied, including, but not limited to the implied warranties of merchantability or fitness for a particular use or purpose. I have read and agree to the above terms and conditions. *