Cat Owner Surrender Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

What type of Cat or Kitten are you surrendering?

Cats Name (all of them if you have multiples)

Breed

Sex of the cat

Age of the cat

Reason for surrendering

Does your cat see a Veterinarian for annual vaccines?

Name of Vet Clinic he/she sees.

Who's name will your cat be under at the Vets office listed above?

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.

! Relinquishing Receipt for Animal surrendered to NEPA CAT RESCUE Animal Control by Owner

* I hereby give NEPA CAT RESCUE permission to request all medical history and medical records from my Veterinarian for the animal I am relinquishing.

* I hereby acknowledge that this animal is in fact owned by myself and I have the authority to surrender such animal as I deem fit.

*I acknowledge that my signature on this receipt relinquishes all claims of ownership of the animal(s) described.

*Neither my family, any representatives acting on my behalf, nor I may assert present and/or future claims, suites, or otherwise against NEPA CAT RESCUE with respect to this animal(s).

*I understand that the NEPA CAT RESCUE will not return this animal to me, once left in its care, under any circumstances, unless otherwise approved by the NEPA CAT RESCUE Animal Control Director.

Signature