Animal Surrender Form

Animal Surrender Form
Owner / Finder / Foster Contact
Name*

First NameLast Name
Phone*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Background
Who are you to the cat(s)

OwnerFinderOther (Explain Below)
Notes:
Do you agree that you are legally able to sign rights of this cat over?

Yes I am legally able to sign rights overNo I can not sign over this petOther
What arrangement are you interested in? Select ALL that apply!

Full SurrenderFostering (You keep possession of them, but have no rights to them.)You cover food / litter while fosteringYou need daily cat expenses covered - food & litterDonation to the rescue towards expensesOther
Notes:
Pet Information
Number of cats
List All Names, Ages, Genders, Markings, & Other Info For All Cats?
How long have you had the cats?*
Where did you get the cats?*
Why are you surrendering the cats?*

Including yourself, how many people of the following ages live in your home?*

	FEMALE	MALE
00 - 03
04 - 09
10 - 17
18 - 29
30 - 59
60 +

What other animals did the boxer live with?*

no other animalsdogscatsOther
BEHAVIOR

Your cats usual behavior
How does the cats usually behave towards animals they know?
DO KNOW
How does the cats usually behave towards animals they DO NOT know?
DO NOT KNOW
How many hours a day is the cat left alone without a human?*

never1-3 hours4-8 hours9-12 hoursover 12 hours
When left alone, is he/she...*

outdoorsfree roam in homeconfined to a roomcratedOther
Are the cats scared of anything*

yesno
If yes, please explain
Please tell us the cats bad habits*
Where do the cats usually sleep at overnight?*

crateflooryour bedcouchkids bedpet bedoutsideOther
Select all that apply

Scratch FurnitureSprayingUses the bathroom outside of the litter boxAggressiveCant be trusted aloneOther
Describe the personality of each cat
Anything you’d like to add?
MEDICAL
Please select all that apply

Cats have NEVER seen a vetCats have ONLY seen a vet in an emergencyCats seen a vet regularlyCats are current on ALL vettingCats are current on MOST vettingI have records or can get vet recordsCats have seen a vet in the last 6 monthsOther
Please list all veterinarians that have seen the cats, including address and number.*
Is the cat spayed/neutered?*

yesno
What vaccinations has the boxer recieved?*

rabiesFVRCPFELVnone
Are vaccinations current?*

yesno
Has the cat been tested for Fiv/FELV?*

yesnoOther
If yes, what were test results, when, & where was the test performed?
Is the cat microchipped?*

yesno
Do you have updated microchip information & can you access it?
Are any cats showing signs of injuries, illness, or other emergencies at this time? Explain!
Be specific
Do the cats have any past or present health problems?*

yesno
If yes, please describe
Be as specific as possible - dates, diagnosis, meds given, tests given, tests results, etc. Any & all info you know
Is the cats currently taking any medication?*

yesno
If yes, please list medications
Select all that apply

Cat is blindCat is deafCat has physical disabilityBottle feeding is requiredNursing concernsMother can’t be trusted alone with kittensRecently gave birthOther
Any other medical history, injuries, or special needs?
FEEDING
What type of food do the cats eat?*

canneddryWetOther
How many times a day are the cats fed?*

1 time2 times3 timesfree feeds
How much are the cats fed during feedings?
OTHER
Please feel free to tell us any other information about the cats you feel could be important.
Please upload a full body picture of each cat*

Cancelof
Please upload a up close head shot of each cat*

Cancelof
Please upload any records you have for each cat

Cancelof
Contract
I, Nameagree on Datethat all information provided is true & to my best knowledge. I understand that I am giving up all rights & ownership of the pets listed below:
Names & physical description of pets you are surrendering.
Signature

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Animal Surrender Form

Owner / Finder / Foster Contact

Background

Pet Information

BEHAVIOR

MEDICAL

FEEDING

OTHER

Contract