Surrender Application

Surrender Form
This form is designed to hlep us place your cat in a loving permanent home with people who understand his/her needs. Undesirable behaviors and medical issues do not necessarily create problems in placement, however, not disclosing those problems definately would. Please provide as much detail as possible.

Completion and submission of this form does not automatically mean that Safe Haven Animal Shelter have accepted your cat for surrender. A SHAS representative will review your application and be in contact with your shortly.
Surrender Date

MonthDayYear
Date
Cat's Name
Why are you surrendering this cat?*
Date of Birth or Approximate Age*
Where did you get this cat?
How long have you had this cat?*
Gender:*

Male NeuteredMale Not NeuteredFemale SpayedFemale Not Spayed
If this cat is altered, where was this done?
Declawed?

NoYes Front feetYes All 4 feet

As the owner or agent of the animal(s) described herein, I do hereby assign ownership of said animal(s) to Safe Haven Animal Shelter. Safe Haven Animal Shelter will become the sole owner of the animal(s) and may care for the animal(s) in any manner Safe Haven Animal Shelte sees fit.

To the best of my knowledge, as owner or agent of the anima(s), this animal HAS NOT bitten anyone in the past 10 days.
Name*

First NameLast Name
Address*

Street Address

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Surrender Form