Barn Cat Placement Application

Due to the nature of the program, we approve the application first and then will provide the cat(s) within a couple of weeks.

INSTRUCTIONS: Please fill out the full application. A Darbster Kitty representative will contact you upon review of the application -typically within 2-3 days. You may call 561-876-7203 if you do not hear back within three days.

Name

First Last

Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Work Phone

Applicant Occupation

Email

Living Accommodations:

If other please explain

Landlord/Apartment Manager Name

First Last

Landlord/Apartment Manager Phone

Personal Reference Name

First Last Phone Number

Do you live here full-time?

Have you ever been convicted of a crime regarding animal cruelty or child/domestic abuse?

Describe the structure in which the cat will be housed:

What is the size and description of your property:

Why do you want a barn cat?

Barn cats must be securely confined for 3-4 week. Are you prepared to allow this much time?

Who will be responsible fore the barn cats’ care?

Who will care for your barn cats if you are away?

Do you agree to trap and take to a vet a barn cat that becomes ill or injured?

Have you had barn cats before?

What happened to the cats that are no longer with you?

I have read the above information carefully and have filled out the application honestly.

By signing below, I certify that the information I have given is true. I understand that omission of information and/or
failure to answer all asked questions honestly can result in this application being declined. Also, if an omission,
untruth or neglect is discovered after adoption takes place, I understand that Darbster Kitty reserves the right to annul
the adoption and reclaim the animal. I give Darbster Kitty permission to fully investigate the information provided
and related officials. I understand that feral and semi-feral cats can be unpredictable and as a caretaker I will take
proper precaution and understand that Darbster Kitty cannot be held liable.

Signature*

Date