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2. This Program Includes:

   - Spay or neuter surgery
   - Left ear tip (required for participation)
   - Rabies Vaccination
   - Capstar flea treatment

4. Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
17. Information about Cat(s):
19. Number of Cats being Trapped:*
    -- Select One --123456+
21. Color(s)/Description of Cat(s):*
23. Approximate Age of Cat(s):*
27. Feral Cat Status Questionnaire

    Please answer all questions honestly.  This program is intended only for unowned, truly feral cats.

29. Where did you find or trap the cat(s)?*
30. How long have the cat(s) been living at this location?*
32. Can you safely touch or handle the cat(s)?*

    1. Yes

    1. No
33. Do the cat(s) approach people willingly or act social?*

    1. Yes

    1. No
35. Has anyone claimed ownership of this cat or allowed it indoors?*

    1. Yes

    1. No
36. Are the cat(s) currently living outside without access to regular indoor shelter?*

    1. Yes

    1. No
40. Agreement & Terms of Feral Cat Program:

    - I understand this program is intended only for unowned, feral cats.
    - I understand that this program is only for cats found within the City limits of Brookville and for City of Brookville Residents.
    - I agree that all cats will be ear-tipped on the left ear during surgery.
    - I understand that the City of Brookville may decline services if the cat is determined to be socialized, owned, or not feral. 
    - If a cat is determined by the veterinary team to be owned, socialized, or not appropriate for the feral program, I agree to be financially responsible for, ALL veterinary costs incurred, including, but not limited to surgery, vaccines, and exam fees.  
    - All cats must be returned outside to the location they originated from. 
    - I confirm the information provided above is truthful to the best of my knowledge.  

42. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
44. Electronic Signature*
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field