Cat Surrender/Intake Request

P.A.W.S. Cat Surrender Request Form

This form signifies your intent to surrender a cat to the shelter and places you on the waiting list. Persons who surrender a pet to the shelter will not be eligible to adopt the animal back at any time. If you have more than one animal, please submit a form for EACH animal.
Your Name*
Your Email*
Your Phone*
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Why do you want to surrender this cat? (Check all that apply)*

Financial ReasonsBehavioral ReasonsWill not use the litter boxMoving and cannot take the catChange in my familyPersonal illnessAnimal illnessOther
Animal's Name*
Breed*
Color(s)*
Weight
Age:
Socialization*

Sweet and socialA little shy but warms up when you're niceVery shyFearfulAggressiveBarn Cat / Feral
Is this cat good with other animals (cats/dogs)? if no, please give some details.*
Where did you this cat?*
How long have you had this cat?*
Describe in detail why you want to surrender this cat?*
Is your cat current on all vaccinations (Rabies / Distemper)*

RabiesDistemperOther
When was the last time you administered a Flea & Tick preventative/medication
Has your cat been altered (spayed or neutered)?*
Is your cat FIV+*

YesNoUnknown
Does your cat have Feline Leukemia?*

YesNoInknown
Is this cat declawed*

YesNo
Does your cat have any medical conditions, special diets, etc.... please explain:
Can you provide vet records for this animal?*

YesNo
If you have taken this animal to the Vet, please provide the Veterinary contact info (clinic, Dr. etc)
Please upload a photo of your cat.
I confirm that the information that I have provided about this surrendered animal(s) is, to the best of my knowledge, a true and accurate depiction of its health, temperament, and behavior. I am verifying the truth of the above information and I understand that I can be held legally responsible for any medical care or other damages that result from false or misleading information on this form. I understand that by surrendering ownership of this animal(s), I am forfeiting the right to adopt this animal(s).

I also understand that there is a surrender fee for this animal and I am responsible to pay this at the time of surrender.
Submitting this form does not confirm that we will accept your animal.

You will be contacted within 48 business hours with additional information.
Just to be clear. When you surrender an animal, you will not be allowed to adopt this animal back at any point.
Please use your mouse (computer) or stylus (tablet) to sign your name:*
Should be Empty:

P.A.W.S. Cat Surrender Request Form