Cat Owner Surrender

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cat's Name

Breed

Sex of the cat

Age of the cat

Spayed/Neutered

Health Condition

Are vaccination records available?

Picture of the cat

Please provide details on why you are surrendering ownership of the cat

Name of Vet Clinic he/she sees.

Does your cat use the litter box?

If you answered sometimes, how often does he/she make mistakes?

What type of litter does your cat use?

What type of litter box does your cat use?

What is your cats favorite toy? (please select all that apply)

How does your cat like to play? (please select all that apply)

What areas of your home did the cat have access to? (please check all that apply)

Where did your cat spend most of its time? (please check all that apply)

Does your cat have any of the following behavioral issues?(please check all that apply)

Explain your answer of other here.

Authorization and Agreement:

Authorization to Surrender: I, the undersigned, authorize the surrender of ownership of the above-named cat to [Organization/Shelter Name].

Release of Information: I understand that the information provided on this form may be used by [Organization/Shelter Name] for the purpose of rehoming the cat and may be shared with potential adopters.

Health Records Release: I authorize the release of any available health records and veterinary information related to the cat to [Organization/Shelter Name].

Signature

Date Signed

Date

Cat Owner Surrender Form