Cat Surrender Request Form

Are you willing to pay $30 (per adult cat) or $15 (per kitten, $80 cap) surrender fee? *

Yes No I am unable to pay a surrender fee

Date

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Please enter a valid phone number.

Email (primary way we will contact you) *

example@example.com

I NEED TO SURRENDER (Enter #)* CAT(s).

Reason For Surrender: *

If this is a litter of kittens, do you want to surrender their Mom?

Yes No

Name of Cat: *

How long have you owned the cat? *

This Cat is: *

Male Female Unknown Litter of Kittens

Where Did you get the cat? *

Shelter/Rescue Found Stray Pet Store/Breeder Giveaway Other

If from another shelter or rescue, which shelter/rescue?

Has this cat been seen by a Veterinarian? *

Yes No

If yes, What vet do you use for the cat?

Does the animal have any past or current medical concerns or conditions? *

Yes No

If YES, please describe the animal's medical concerns and/or conditions:

Is this cat spayed/neutered? *

Yes No Unknown

Is this cat current on vaccines? (if yes, you will need to present paperwork on the day of surrender) *

Yes No Unknown

Is the cat good with (select all that apply): *

Men Women Children Other Cats Dogs Unknown

Is this cat NOT good with (select all that apply): *

Men Women Children Other Cats Dogs Unknown Cat is good with all of the above

Breed/Description:

Can the cat easily be caught, picked up, and carried? *

Yes No

Attach a photo of the cat that you would like to surrender: *

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Please provide any additional information about the cat below.