Cat Surrender Application
NOTE: Filling out an application does not guarantee we will be able to accept your cat into our shelter. You will receive a reply to your application within 1-2 weeks to determine if we can place you on our admission waiting list. Be as detailed as possible when completing this application. Please note: If you are completing this application for a cat that was adopted from us within the past 30 days you will hear from us within 24-48 business hours Monday-Friday.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Please Select
Geauga
Lake
Ashtabula
Portage
Cuyahoga
Trumbull
Mahoning
Summit
Other
Phone Number
*
Please enter a valid phone number.
Email-If you do not have email write: intake@rescuevillage.org
*
example@example.com
Cat's Name (ONE form per cat is required. If you have multiple cats to surrender, you need to complete multiple applications. For kittens under 4 months, complete our kitten surrender application.)
*
Cat's Age
*
Male / Female?
*
Please Select
Male
Female
Unknown
Spayed / Neutered?
*
Please Select
Yes
No
Unknown
Breed
*
Color
*
Is the cat declawed?
*
Please Select
No
Yes, front paws only
Yes, all four paws
Unknown
If yes, WHEN was the cat declawed?
If you are able, please upload a photo of the cat here:
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How long have you owned the cat?
*
Where did you originally get the cat?
*
What is the reason you need to surrender this cat? Please give as much detail as possible:
*
Where does the cat spend most of their day?
*
Where does the cat spend most of their night?
*
Does the cat like being picked up/held?
*
Yes
No
Haven't tried
Other
What is the cat's personality like? Check all that apply:
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Friendly
Outgoing
Shy
Shy at first, but warms up quickly
Playful
Affectionate
Independent
Fearful
Aggressive
Demanding
Lap Cat
Other
What are your cat's best qualities? How would you best describe your cat?
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What does your cat play with? What are their favorite toys?
*
Does your cat ever get too excited (over stimulated)? If so, what causes this?
*
What is the cat scared of?
*
How does the cat react when visitors come over?
*
Who lives in the home? Please check all that apply:
*
Adult women
Adult men
Senior citizens
Infants
Children aged 2-5
Children aged 6-9
Children aged 10-12
Teenagers (12+)
Other cats
Dogs
Other
If applicable, how does the cat react to children?
If the cat lives with other animals, please provide as much detail as possible about their relationship with other animals in the home:
Has the cat ever bitten someone? (A bite is defined as breaking skin with teeth that causes bleeding)
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Yes
No
If yes, please explain:
Has the cat ever been to a vet?
*
Yes
No
If yes, how do they react at the vet?
*
Current Veterinarian Name & Phone number:
Date of last Rabies Vaccine:
-
Month
-
Day
Year
Date
Date of last FVRCP Vaccine:
-
Month
-
Day
Year
Date
Please list any medications, including flea/tick preventative, that the cat is on and when it was last given:
If able, please upload the cat's current medical records. (NOTE: Receipts and invoices are not considered medical records)
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What brand of food does the cat eat?
*
This cat eats:
*
Dry Food
Wet Food
Both Dry & Wet Food
Other
How many litter boxes are in the home?
*
Where are they located?
*
What type of litter do you use?
*
How often do you clean the litter box(es)?
*
Does the cat ever go to the bathroom OUTSIDE of the litter box?
*
Please Select
No, Never
Yes, urinates outside of box
Yes, defecates outside of box
Yes, both urinates & defecates outside of box
If you noted litter box issues above, how often is this happening? Please give as much detail as possible:
This question is not mandatory if your cat is not having this issue.
When did the litter box issues start? At that time, were there any significant life changes in your home or routine (such as a move, a new baby, remodeling)?
This question is not mandatory if your cat is not having this issue.
Where is the cat inappropriately eliminating (i.e. on a bed, in a laundry pile, etc.)?
This question is not mandatory if your cat is not having this issue.
What steps have you taken to correct any litter box issues?
This question is not mandatory if your cat is not having this issue.
If the cat has litter box issues, have they been checked by a veterinarian for this problem? If so, what were the results?
This question is not mandatory if your cat is not having this issue.
What is the date of the last time the cat did not use the litterbox?
-
Month
-
Day
Year
This question is not mandatory if your cat is not having this issue.
I agree to check my email (including my junk/spam folder) regarding important communication from Rescue Village in regards to this surrender form.
*
I understand and will check my email AND junk/spam folder
I do not have email and will require a phone call instead.
I understand that I MUST have an intake appointment and that the shelter does not accept walk-in surrenders.
*
I understand
I understand that Rescue Village requires an intake fee of $50 per cat to help offset the cost of caring for this cat during it's time with us. Under certain circumstances, we can reduce or waive this fee, but it must be discussed with the Intake Manager prior to your intake appointment
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I understand and can provide the full fee.
I understand, but am asking for a reduced or waived fee.
I understand that Rescue Village is NOT an open admission shelter and that Rescue Village is a limited admission, unlimited stay humane society. I understand my application can be denied for any reason.
Please Select
I agree and understand that Rescue Village may deny my application for any reason.
I do not agree and will seek other options. I understand I will not be contacted by selecting this option.
By signing below, I understand that Rescue Village has the right to deny my surrender form for any reason. I also understand that if my surrender form is accepted, there may be a lengthy wait because Rescue Village does NOT euthanize animals for time or space reasons and can only schedule in cats as cage space allows.
*
Submit
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