Clone of Canine Department Request to Surrender

Required Details:

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Format: (000) 000-0000.

E-mail

example@example.com

Cat Details:

Cat's Name*

Cat's Age*

Cat's Breed*

Cat's Color or Markings*

Cat's Gender*

MaleFemale

Is your cat spayed/neutered?*

YesNo

Is your cat declawed*

YesNo

Is your cat up to date on vaccinations?*

YesNo

Who is your current veterinarian?*

What kind of food does your cat eat?*

Does your cat have any old/new injuries or health issues?*

YesNo

If yes, please explain

Is your cat litter box trained?*

YesNo

Does your cat require special litter*

YesNo

Does your cat urinate/defecate outside of the litter box?*

YesNo

If yes, please explain

How long have you had the cat? *

My cat stays primarily: *

Where did you get the cat? *

If you selected "Another Shelter" or "Other Shelter" Please Specify

Please explain why you are choosing to surrender your cat: *

Please explain the steps you have taken to resolve the issue or rehome your pet: *

Describe your cat's personality*

My cat has successfully lived with: (Select all that apply)*

If there have been any issues with people, please explain:

Has your cat ever been destructive in your home?*

YesNo

If yes, please explain:

Has your cat ever bitten anyone?*

YesNo

If yes, please explain:

Anything else we should know about your cat?

I acknowledge:

1. I am relinquishing all claims of ownership associated with this animal if I surrender it to the Humane Animal Treatment Society.

2. I have filled out this form accurately and with true information regarding this animals, and I understand that providing false infomration only negatively impacts the animal and their chance of finding a new home.

3. If and when this animal is made available for adoption is at the sole discretion of the Humane Animal Treatment Society.

4. The Humane Animal Treatment Society does, in certain circumstances, humanely euthanize animals for unmanageable aggressive behavior or serious health issues that exist upon intake or arise during the animal's stay.

5. I understand that by relinquishing this animal I will be unable to adopt from the Humane Animal Treatmetn Society for a minimum of one year from today's date.

Signature*

Feline Department Request to Surrender