Surrenderer Information
Your Full Name (as it appears on your driver's license/state ID):
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First Name
Last Name
Your Phone #:
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Your E-mail:
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Your Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please tell us why you have chosen to surrender.
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If you are looking to surrender your owned personal cat(s), what would have to happen to make you keep them?
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Have you reached out to any other local rescues and shelters for assistance? If yes, please list who.
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If you are surrendering a kitty you found, would you be willing to foster him/her under Kitty Co. Cat Rescue until they are adopted? KCCR pays for all supplies and vetting.
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Yes
No
Are you able to bring the kitty(ies) to our location in Bridgeville, PA when we have the availability for them?
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Yes
No
Will you be donating anything towards the kitty(ies) care?
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Yes, items
Yes, a monetary donation
Not at this time
Kitty Information
How old is the kitty(ies) you are looking to surrender? *please check all that apply
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Neonatal Kitten (Newborn-5 wks old)
Young Kitten (1-6 mos old)
Junior Kitten (7-11 mos old)
Adult Cat (>1 yr old)
Senior Cat (>11 yrs old)
Age Unknown
Please list the details of each kitty you're looking to surrender.
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Have any of the kitty(ies) recently tested positive for or shown any symptoms of feline panleukopenia (FPV) AKA feline parvovirus (vomiting, diarrhea, not eating/drinking, lethargy)? Have you had any contact with any kitties in or outside of your home that may have FPV?
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Yes
No
Have any of the kitty(ies), your household members, or any animals at home recently had ringworm (fungal infections)? Have you had any contact with any animals or people outside of your home that may have ringworm?
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Yes
No
Has the kitty(ies) recently been dewormed?
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Yes
No
When were they recently dewormed?
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Has the kitty(ies) recently been flea/tick treated?
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Yes
No
When were they recently flea/tick treated?
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Does the kitty(ies) have any known health conditions, special needs, or require medications?
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Yes
No
Please list what known health conditions, special needs, or required medications the kitty(ies) have.
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Does the kitty(ies) have any bad/difficult behaviors we should know about?
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Yes
No
Please list what bad/difficult behaviors the kitty(ies) have.
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Has the kitty(ies) ever seen a veterinarian?
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Yes
No
Please provide us with the facility name and phone number.
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Is there anything else you would like to tell us?
How did you find out about Kitty Co. Cat Rescue?
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Google Search
Facebook
Instagram
PetFinder
Adopt-A-Pet
Family member/friend
At a vendor show/adoption event
PetSmart
KCCR Cat Lounge
Other
Sign and Submit
By signing below, I agree that I have disclosed any and all material information regarding the medical behavioral history of said Cat(s). Upon surrendering, I will hand over any and all medical records and information and give KCCR and its representative’s permission to contact the current treating veterinarian for any records or information which might be in their possession. I understand upon surrendering, that I will be required to relinquish all rights of the kitty(ies) I am handing over to KCCR by signing a surrender contract.
Signature
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Save and Continue Later
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