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2. Colony Caretaker Online Application
   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. How Would Your Like Us To Respond To You?*

    1. At The Phone Number Listed Above

    1. At The Email Address Listed Above
18. When Is The Best Time To Reach You By Phone?*

    1. Weekday Mornings
    2. Weekday Afternoons

    1. Weekend Mornings
    2. Weekend Afternoons
20. Please Provide The Location Of The Free Roaming Cats (Approximate Address, Cross Streets, Business Name, etc)*
22. Approximate # Adult Cats In Colony*
23. Approximate # Kittens (Under 12 Weeks)*
25. Do Any Of The Cats Appear To Be Injured Or Diseased?*

    1. Yes

    1. No
27. Please Describe The Care (Feeding Times, Water, Shelter) That You Are Providing Or Intend To Provide To The Colony*
29. 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 TNR Best Practices Standards applicable to my role as a free roaming Colony Caretaker:
31. I am responsible for providing food, water and shelter for my colony.*

    1. I Understand & Agree
33. I am responsible for making every effort to ensure that all cats in my colony (including new cat arrivals) are vaccinated against rabies, spay/neutered, and ear tipped.*

    1. I Understand & Agree
35. 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
37. I recognize the inherent risks to anesthesia and surgery, particularly for cats that are pregnant, in heat, injured, sick and/or have no medical history available.*

    1. I Understand & Agree
39. I recognize that the cat(s) do NOT undergo a pre-anesthetic evaluation by a veterinarian.*

    1. I Understand & Agree
41. By presenting these cat(s) for surgery, I accept the risks for any underlying health problem that would complicate surgery and/or recovery.*

    1. I Understand & Agree
43. 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, and agree to conduct your responsibilities in accordance with the TNR Colony Caretaker Best Practices listed above.
45. Electronic Signature*
    Please type in your full legal name.
46. Today's Date*
    Today's Date
48. 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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50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

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