Cat Owner Surrender Form

Cat Owner Surrender Form

NEPA CAT RESCUE Inc.
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
Good Samaritan - Found a litter of Kittens with momGood Samaritan- Found a litter of Kittens without momOwner- Surrendering my own catLandlord- Previous tenant left behind cat/kittens
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?*
Stuffed MiceCatnip ToysLaser PointerFeather/String WandsAll ToysNone
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
Outdoors OnlyIndoors at nightOutdoors in warm weatherScreened in porchGarageIndoors in coldIndoors with access to outsideBarn or shed
BedroomKitchenLivingroomBarn or ShedWith peopleGarageAt the windowOutdoors only
Scratching FurnitureJumping on countersSprayingChewing electric cordsEscaping outsideClimbing curtainsSwatting aggressivelyChewing PlantsOther: Please answer next question.
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*

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