Cat Surrender Application
Filling out an application does not guarantee that we will be able to accept your cat into our shelter. For appropriate review of your application and to prevent delays, we ask that you are 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.
Format: (000) 000-0000.
Email
*
example@example.com
Cat's Name
*
One pet per form. If you have multiple cats you want to surrender, you will need to complete multiple applications.
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:
*
We must ask many questions to collect an accurate history on owner surrender requests. If you are not able to provide details about your cat on this application, we will be unable to contact you regarding your request.
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:
*
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?
*
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)
*
Yes
No
If yes, please explain:
What brand of food does the cat eat?
*
This cat eats:
*
Dry Food
Wet Food
Both Dry & Wet Food
Other
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 FVRCP Vaccine:
-
Month
-
Day
Year
Date
Date of last Rabies Vaccine:
-
Month
-
Day
Year
Date
If able, please upload the cat's current medical records. (NOTE: Receipts and invoices are not considered medical records)
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Please list any significant health issues the cat has:
*
Please list any current medications, including flea/tick preventative the cat is on AND when these medications were last given:
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 required 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 required 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 required if your cat is not having this issue.
What steps have you taken to correct any litter box issues?
This question is not required 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 required 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 required if your cat is not having this issue.
I understand that Rescue Village has a service area and that if I am outside of that service area, I may be directed to other agencies for assistance depending on the situation, shelter capacity, waiting list length, etc.
*
I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
I understand that Rescue Village requests an intake fee of $50 per cat to assist with cost of care.
*
I understand and can provide the full fee.
I understand, but am asking for a reduced or waived fee.
I understand that I MUST have an intake appointment and that Rescue Village does not accept walk-in surrenders.
*
I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
I agree to check my email (including my junk/spam folder) regarding important communication from Rescue Village in regards to this surrender application.
*
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 Rescue Village is NOT an open admission shelter, meaning not every application is able to be accepted. I understand that Rescue Village is a limited admission, unlimited stay humane society and that my application can be denied for any reason.
*
I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
I understand that if my application is accepted, I may be placed onto a waiting list as Rescue Village never euthanizes for space. I understand that this waiting list may be lengthy.
I understand
I am unable to wait and will seek out other options. I understand by selecting this option I will not be contacted.
Please understand that pets often behave differently in a shelter environment than they do at home or in their outdoor home due to stress and unfamiliar surroundings. For this reason, shelter surrender is not always the best or most appropriate option for every pet.
I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
Rescue Village reserves the right to decline surrender requests at its discretion. We kindly ask that all interactions with our staff remain respectful. Any use of inappropriate behavior may result in refusal of services.
Please Select
I agree
I do not agree and will seek other options
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 animals as species appropriate space allows.
*
Submit
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