CAT SURRENDER FORM

Cat Surrender Form
Please keep in mind that the more accurate information we have about your cat, the better able we are to place them in an appropriate home.

There is a surrender fee of $40 if your cat is current on vaccinations spayed/neutered and you provide documentation The surrender fee is $60 if your cat is not current on vaccinations, spayed/neutered or if you do not have documentation These fees contribute to the care of your cat and help keep the shelter open.
Personal Information
Name*

First NameLast Name
Date*

MonthDayYear
Date
Address*

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
Phone*
Driver's License#*
Email
example@example.com
Cat Information
Name
Age/DOB*
Sex*
Breed
Color(s)
Spayed/Neutered?*
Micro-chipped?
If yes. chip number and/or company
How long have you had your cat?*
Where did you acquire your cat?*
Why are you surrendering your cat?*
Feeding Information
Does your cat eat wet food?
If yes, what kind?
How much?
How often?
Does your cat eat dry food?
If yes, what kind?
How much?
How often?
Does your cat have a favorite treat?
If yes, what is it?
Cat's Habits and Behaviors
Does your cat have a favorite type of toy?
If yes, what is it?
How many hours per day is your cat indoors?*
How many hours per day is your cat outdoors?*
Does your cat have accidents outside of the litter box?*
If yes, how often?

DailyWeeklyMonthlyOther
What are the ages of people your cat has lived with?
Men
Women
Children
Describe your cat's behavior with MEN (select all that apply)

FriendlyPlayfulAffectionateShy/TimidFearfulAggressiveOther
Describe your cat's behavior with WOMEN (select all that apply)

FriendlyPlayfulAffectionateShy/TimidFearfulAggressiveOther
Describe your cat's behavior with CHILDREN (select all that apply)

FriendlyPlayfulAffectionateShy/TimidFearfulAggressiveOther
What animals has your cat lived with?

DogsCatsBirdsReptilesOther
Has your cat bitten/injured anybody?*
If yes, please explain
Veterinary Information
Who is your cat's veterinarian?*
When was your cat's most recent vet appointment?

MonthDayYear
Date
Does your cat have any current or past medical conditions?
If yes, what are they?
Is your cat currently on any medication(s) or a special diet?
If yes, what?
I attest that I am the legal owner of the cat described above, or duly authorized agent thereof.

I hereby relinquish and transfer ownership of this animal to The Humane Society of Ottawa County (HSOC).
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Cat Surrender Form

Personal Information

Cat Information

Feeding Information

Cat's Habits and Behaviors

Veterinary Information