Cat Owner Surrender

Cat Owner Surrender Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cat's Name*
Breed*
Sex of the cat*
Age of the cat
Spayed/Neutered
GoodFairPoor
Are vaccination records available?
Picture of the cat*

Cancelof
Please provide details on why you are surrendering ownership of the cat*
Name of Vet Clinic he/she sees.
Does your cat use the litter box?*
If you answered sometimes, how often does he/she make mistakes?
What type of litter does your cat use? *
What type of litter box does your cat use?*
Stuffed MiceCatnip ToysLaser PointerFeather/String WandsAll ToysNone
Plays gently, does not usually use teeth or clawsLikes to play roughLikes to chase and pounce with variety of toysLikes things that crackle, such as paper bagsLikes to play hide and seekWill fetch items like bottle caps or toysLikes to play in or around waterLikes to learn new tricks for treatsLikes to play with other catsLikes to play with dogsNot interested in playChases bugs or moths
Outdoors OnlyIndoors at nightOutdoors in warm weatherScreened in porchGarageIndoors in coldIndoors with access to outsideBarn or shed
BedroomKitchenLivingroomBarn or ShedWith peopleGarageAt the windowOutdoors only
Scratching FurnitureJumping on countersSprayingChewing electric cordsEscaping outsideClimbing curtainsSwatting aggressivelyChewing PlantsOther: Please answer next question.
Explain your answer of other here.
We are a small grassroots 501c3 Animal Rescue in Charlotte, NC.

Our mission is to help pets deemed 'undesirable' and 'unworthy' by the public and get them adopted into loving homes.
1. We have a pet food bank to support those facing financial hardships. If you need food for your pets, please fill out our pet food bank form. We always prefer to keep pets with their owners over having them surrendered to us.
2. At times, we may help out with medical expenses for pets but that is all dependent on the donations we receive and is never guarateed.
3. If you are in need of end-of-life services for your beloved pet, we will help you find resources available to you.
*We evaluate surrenders on a case-by-case basis.*

*At this time, we are unable to take any pets with serious medical issues (i.e heartworm disease, positive for parvo, distemper, ringworm, etc)*

We prioritize areas and regions where animal shelters are overrun with animals and need rescues to step up in order to eleveate resources.
1. This means that we will only be taking owner surrenders from North Carolina, South Carolina, and on rare occasions, Georgia.
2. If you are outside of these states, we will try to find rescues to connect you with in your area that may be able to help you.
If you have any questions, please reach out to us at cltshelteredsoulsanimalrescue@gmail.com for more information.
Authorization and Agreement:

Authorization to Surrender: I, the undersigned, authorize the surrender of ownership of the above-named cat to Charlotte Sheltered Souls Animal Rescue. I acknowledge that my signature on this receipt relinquishes all claims of ownership of the animal(s) described. Neither my family, any representatives acting on my behalf, nor I may assert present and/or future claims, suites, or otherwise against Charlotte Sheltered Souls Animal Rescue with respect to this animal(s). I understand that the Charlotte Sheltered Souls Animal Rescue will not return this animal to me, once left in its care, under any circumstances, unless otherwise approved by the founder(s) or members of Charlotte Sheltered Souls Animal Rescue.

Release of Information: I understand that the information provided on this form may be used by Charlotte Sheltered Souls Animal Rescue for the purpose of rehoming the cat and may be shared with potential adopters.

Health Records Release: I authorize the release of any available health records and veterinary information related to the cat to Charlotte Sheltered Souls Animal Rescue.
Signature*

Powered by Jotform SignClear
Date Signed

MonthDayYear
Date
Should be Empty:

Cat Owner Surrender Form