ANIMAL HISTORY FORM

ANIMAL HISTORY FORM - CAT
The Animal Protection Society - Friday Harbor's policy for owner relinquished cats: APS-FH accepts pre- approved owned animals from San Juan County residents. In relinquishing your animal to APS-FH you must understand and agree to the following:
- You are the legal owner of the animal you are relinquishing.
- You are at least 18 years of age.
- Admissions to APS-FH will be assessed on physical and behavioral health of the animal to determine adoptability as well as space available at the shelter. APS-FH reserves the right to deny a relinquishment to the shelter for any reason.
- YOU WILL ANSWER THE QUESTIONS ACCURATELY AND THOROUGHLY TO PROVIDE THE BEST CARE FOR THE ANIMAL AND FOR THE SAFETY OF THE SHELTER STAFF/VOLUNTEERS.
Owner Information
Name
If owner is deceased, guardian name
Address
Phone Number
Format: (000) 000-0000.
Alt Number
Email Address
example@example.com
General Information - Cat
Name
Age/DOB
Sex

MaleFemale
Spayed/neutered

YesNo
Color(s)
Pattern
Breed
Microchip

YesNo
Microchip Brand
Microchip #
Does your cat have any allergies, health problems, or injuries?

YesNo
If yes, please describe.
Does your cat have any special needs? EX. Blind, deaf, injured, sick, seizures, pregnant, bottle fed
Is your cat on any medications?

YesNo
If yes, please describe.
Are you the cat's original owner?

YesNo
If you are not the original owner, please give us as much previous history as possible.
How long have you had the cat?
Where did you acquire the cat?
Are you obligated to return the cat to the person/organization you received them from?

YesNo
Veterinary clinic that your cat frequented
Phone Number
Format: (000) 000-0000.
Date of last vet visit

MonthDayYear
Date
Name of the person that the records are under
What issues are you having with keeping this cat?

BehaviorCannot affordPet illnessChange in familyMovingHousingHealth of ownerAllergiesNeglect
Please explain the situation in greater detail:
How can we help you with the issues that you are having with your cat?
If we could help you re-home your pet, would you consider housing your cat until a new home is found allowing them to stay in a familiar environment with their family, while they wait for their new family?

YesNo
If yes, what is the maximum time you can house your cat during this search?
Personality Profile
What is your cat's personality like? (Check all that apply):

Likes to cuddleCouch potatoActiveHyperAffectionateDestructiveShyLoves to playIndependentFearfulFriendlyNoisy
Where does your cat sleep?
What does your cat eat? (Check all that apply):

Canned foodDry foodRaw dietHomemade dietPrescription
Brand
How often does your cat eat?

1x2x3xFree feed
Home Environment and Behavior
Describe your pet's behavior around children (Check all that apply):

Never been around childrenUnpredictableRoughGentleAvoids childrenFriendly/playfulNervous/scaredIgnores
What human family members has your cat lived with? (Check all that apply):

Adult menAdult womenSenior citizensTeenagersChildren
Please check all the animals your cat has lived with:

Male catFemale catMale dogFemale dogBirdsRabbits/guinea pigsReptilesLivestock
Describe your cat's behavior around other cats (Check all that apply):

Never been around catsScaredAggressiveFriendly/playfulAffectionateIgnoresBossyLoves to playSubmissive
Describe your cat's behavior around strangers (Check all that apply):

Never been around new peopleScaredFriendly/playfulAffectionateIgnoresBossyAggressiveLoves to playSubmissive
Describe your cat's behavior around dogs (Check all that apply):

Never been around dogsScaredFriendly/playfulAffectionateIgnoresBossyAggressiveLoves to playSubmissive
Where was the cat kept when no human members of your family were home (Check all that apply):

Free run of the homeOutsideConfined to an area
Does your cat have accidents in the house often?

YesNoSometimes
Does your cat use the litterbox?

YesNoSometimes
If sometimes, how often does the cat make mistakes?
How many litterboxes does the cat have access to?
What type of litter did this cat use? (Check all that apply):

ClumpingClayPelletsScentedUnscented
Does your cat have any of the following behavioral issues? (Check all that apply):

Scratching furnitureSprayingEscaping outsideSwatting aggressivelyJumping on countersChewing cordsClimbing curtains
Has your cat ever bitten a person?

YesNo
If yes, please explain the circumstances:
How does your cat like to play? (Check all that apply):

Plays gently, does not usually use teeth or clawsLikes to play in or around waterLikes to play rough, may bite or scratchLikes to learn new tricks for treatsLikes to chase and pounce with variety of toysLikes to play with other catsLikes things that crackle, such as paper bagsLikes to play with dogsLikes to play hide and seekNot interested in playWill fetch items like bottle caps or toysChases bugs or moths
What area of your home did your cat have access to? (Check all that apply):

Outdoors onlyIndoors at nightBasementOutdoors in warm weatherIndoors onlyScreened in porchGarageIndoors in coldBarn or shedIndoors with access to outside
Where did the cat spend most of their time? (Check all that apply):

BedroomKitchenLiving roomBarn or shedWith peopleGarageBasementAt the windowOutdoors only
DONATION

We ask for a donation of $50 in surrendering your cat. Your donation assists in providing food, shelter, and medical care for your animal. Any additional donation is greatly appreciated.

I understand that APS-FH is a 'No-Kill' Shelter for "adoptable" animals. If this animal is determined unadoptable by the behavioral or medical staff and no other alternative can be found, there is a possibility the animal may be humanely euthanized without the original owner notification.

While at APS-FH, all animals receive necessary veterinary care, nourishment, and exercise. There is no set time limit for how long an animal can remain in our adoption program. As long as an animal maintains general good health and sound temperament, we will keep the cat until they are adopted. Unfortunately, there are times when circumstances present themselves (e.g. out of space, sensitive situation) and animals may have to be transferred to another 'no-kill' shelter, however, our goal is to find adopters for all of our

I CONFIRM THAT I AM THE RIGHTFUL OWNER OF THIS CAT AND I HEREBY RELEASE ALL RIGHTS AND GIVE FULL CUSTODY OF THE ANIMAL DESCRIBED ABOVE TO THE ANIMAL PROTECTION SOCIETY - FRIDAY HARBOR.
TO THE BEST OF MY KNOWLEDGE, THE ANIMAL HAS / HAS NOT BITTEN ANY PERSON OR ANIMAL IN THE LAST 10 DAYS.

HasHas not
Print Name
Date

MonthDayYear
Date
Signature
Animal Protection Society - Friday Harbor

938 Cattle Point Rd. Friday Harbor, WA 98250
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ANIMAL HISTORY FORM - CAT

Owner Information

General Information - Cat

Personality Profile

Home Environment and Behavior