Cat Owner Surrender

Cat Owner Surrender Form
Name*
First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
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
GoodFairPoor
Are vaccination records available?
Picture of the cat*
Cancelof
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)*
Stuffed MiceCatnip ToysLaser PointerFeather/String WandsAll ToysNone
How does your cat like to play? (please select all that apply)*
Plays gently, does not usually use teeth or clawsLikes to play roughLikes to chase and pounce with variety of toysLikes things that crackle, such as paper bagsLikes to play hide and seekWill fetch items like bottle caps or toysLikes to play in or around waterLikes to learn new tricks for treatsLikes to play with other catsLikes to play with dogsNot interested in playChases bugs or moths
What areas of your home did the cat have access to? (please check all that apply)*
Outdoors OnlyIndoors at nightOutdoors in warm weatherScreened in porchGarageIndoors in coldIndoors with access to outsideBarn or shed
Where did your cat spend most of its time? (please check all that apply)*
BedroomKitchenLivingroomBarn or ShedWith peopleGarageAt the windowOutdoors only
Does your cat have any of the following behavioral issues?(please check all that apply)*
Scratching FurnitureJumping on countersSprayingChewing electric cordsEscaping outsideClimbing curtainsSwatting aggressivelyChewing PlantsOther: Please answer next question.
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*
Clear
Date Signed
MonthDayYear
Date
Should be Empty:

Cat Owner Surrender Form