* Indicates required field
First Name(s) of Applicant(s)
Last Name(s) of Applicant(s)
Primary Phone Number
Alternate Phone Number
Work Phone Number
How did you hear about The Pixel Fund?
Met at an event
Know a foster or volunteer
Saw on TV
Saw in Newspaper
Word of mouth
I know someone who adopted from The Pixel Fund
What is your preferred method of contact?
How would you like to help The Pixel Fund?
Adoption Events in Florida
Adoption Events in Georgia
Adoption Events in Maine
Local Transporter in Florida
Local Transporter in Georgia
Local Transporter in Maine
Florida to Georgia (or reverse) Transporter
Cat Condo Helper in FL
Cat Condo Helper in ME
What is your age?
Less than 18
Do you have pets?
Current Veterinarian Name & Address (if you do not have one, please enter n/a)
Current Veterinarian Phone Number
Pet #1 Information
Pet #1 - please list your current or previous pet's name
Pet #1 - gender
Pet #1 - species
Pet #1 - Is Pet #1 spayed or neutered?
Pet #1 - Does this pet still live with you? If not, what happened to the pet?
Pet #2 Information
Pet #2 - please list your pet's name
Pet #2 - gender
Pet #2 - species
Pet #2 - Is Pet #2 spayed or neutered?
Pet #2 - Does this pet still live with you? If not, what happened to this pet?
Pet #3 Information
Pet #3 - please list your pet's name
Pet #3 - gender
Pet #3 - species
Pet #3 - Is Pet #3 spayed or neutered?
Pet #3 - Does this pet still live with you? If not, what happened to this pet?
Release of Liability
You will accept the animal and specifically release and hold harmless The Pixel Fund, Pixel’s Posse, Inc., and all of its agents, employees, directors, officers and volunteers from any and all claims and liability in connection with the animal for any reason, and you assume all risks and responsibilities for the care, transport, training and behavior of the animal, including any injury or damage it may cause to people, property or other animals, as well as any rules, regulations or requirements for the importation of pets into the state in which you reside (if you do not reside in Maine or Florida), and licensure and other local ordinances.
No warranties of any kind, including but not limited to health, temperament, viability, age or breed are made by The Pixel Fund.
I attest that the information provided on this application is true and accurate to the best of my knowledge.
I have read and understand the Liability Waiver above.