Feline Surrender Form

Cats Name

Cat's Age

Breed

Color/Markings

Cat's Sex

Spayed/Neutered

Microchipped? Microchipped? Yes No

If yes; microchip number

Surgery tattoo? If “yes”; where?

How long have you had your cat?

Owner Name

Owner Address

Email

Phone

Why are you surrendering?

If the reason is behavioral or medical, please explain any actions you have taken to try to resolve the issue

Is there anything our organization can do that may help you keep your cat?

Where did you get your cat from?

If a breeder or rescue, what is the name and location of the person/organization?

Have you attempted to return your cat to where you got it from? Have you attempted to return your cat to where you got it from? Yes No

If “yes”, what was the reason that they did not take it?

Have you contacted any rescue groups to try to re-home your cat? Have you contacted any rescue groups to try to re-home your cat? Yes No

If “yes”, what was the reason they did not take your cat?

Where does your cat spend their time? Where does your cat spend their time? Indoors Outdoors Both

If both, how much time is spent outside?

Is your cat litterbox trained? If “no” please explain:

Has your cat ever urinated or defecated outside of the litter box? If “yes” please explain

Have you addressed litter box issues with your cat’s veterinarian?

What type/brand of cat litter does your cat use?

Does your cat like to be pet or held? How do they react to being handled?

Has your cat ever bitten another animal? If “yes” please explain

Has your cat ever bitten a person? If “yes” please explain and include whether the person had to be treated by a doctor

How is your cat around children?

How is your cat around dogs?

How is your cat around cats?

How is your cat around strangers?

What is the name of your Veterinarian?

How is your cat at the Veterinarian?

Has your cat ever needed to be sedated for an exam?

Is your cat current on vaccines?

Has your cat ever had any medical concerns?

Does your cat take any medications? If “yes” please list them

What food does your cat eat?

Is your cat declawed? If “yes” please list which feet are declawed

A shelter environment can be more stressful for a cat used to living in a home. Therefore, they have a better chance at finding a home if adopters know what to expect. Please tell us more about your cat at home (examples: are they more playful or relaxed? Where do they like to sleep? Are they affectionate or independent?)

If during their first 7 days in our care, we find your cat to be unable to be adopted out due to a behavior or medical concern, would you be willing to redeem them?

I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in this application may render me civilly liable. I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in this application may render me civilly liable. Yes, I have answered to the best of my ability

Please type your full name and date as your electronic signature