Loudoun Working Cats Application Thank you for offering to open your heart and your property to a feral cat that is in search of a new and safer home. For simplicity sake, we will refer to these cats as “barn” cats however barns are not the only option for these animals. An appropriate location could be a barn, greenhouse, brewery, warehouse, store, office, winery, vineyard, or other similar buildings.Today’s Date MM slash DD slash YYYY How did you hear about us?*WebsiteEmailFacebookOther Social MediaWord of MouthEventOtherContact InformationFirst Name*Last Name*Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Email* Home phone*Work phoneCell phoneBarn/other address Street Address Location InformationDo you own the proposed residence/land? Yes No If you do not own proposed new home, what role enables you to make this request?Do you or does anyone else live on the property? Yes No Please provide full names and relationship of residents.Please describe in detail the property where the cat(s) would live.How large is the property?What type of building will the cat be housed in during acclimation and released to as the primary shelter?Where is the building located?Rate the activity level of the building.On scale 1 = quiet 5 = very activePlease enter a number from 1 to 5.Rate the activity level of the nearest road. Low Medium Heavily Traveled Have you ever had barn cats? Yes No How long did you have them?Where are they now?If they died, what was the cause of death?Do you have a dog? Yes No What kind of dog and is it cat-friendly?Do you have any other animals? Yes No Other InformationHow many barn cats are you interested in?Why do you want barn cats?Are you over 21 years of age? Yes No Will you be the primary caretaker? Yes No If you are not the primary caretaker, please list name(s) and age(s) of who will be taking care of the cats.Please provide any other information you feel would be helpful to us in screening your application.ReferencesProvide two personal references not related to you Reference 1Name First Last PhoneReference 2Name First Last PhoneProvide a veterinary references Name First Last Phone
