Cat Surrender Request Form

Cat Surrender Request
Pennington County Humane Society operates under a managed admission policy, which means we accept animals by appointment only and based on space availability. Please note that submitting a surrender request form does not guarantee we can take in your pet. Each request is carefully reviewed by our team, and if space is available, we will reach out to schedule an intake appointment and complete the surrender process. Due to an unprecedented number of surrender requests this year, we are working hard to prioritize urgent and high-need cases to ensure the best care for each animal. Surrender fees are based on income to help make this service accessible while supporting our shelter operations.
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
Pennington County Humane Society does not have the resources to pick up said animal/s. Can you transport the surrendered animals to our facility?

YesNo
Are you the legal owner of feline?*

YesNo
Owner Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for surrender*
Where did you get this cat from? (examples- Shelter, Breeder, Friend, Found, online, Petstore)*
How long have you had cat/s?*
Have you tried to rehome outside the shelter enviorment.*

YesNo
Feline Informtion
Feline Name*
Breed (Best guess if unknown) *
Age or Best Estimate of Feline*
Is your cat spayed or neutered?*

NoYesOther
Is this feline current on all core vaccinations?*

Yes, this cat is vaccinated, and I DO have vet records.Yes, this cat is vaccinated, but I DO NOT have records.No, this cat is not vaccinated.
Is this feline declawed?*

YesNo
Has this feline bit or scatched anyone in the last ten days?*

YesNo
Does the cat exhibit any rough play? *
Does this cat use the litterbox appropriately?*

YesNo, urinates outside the boxNo, defecated outside the box
If no, did you take steps to correct it? How many boxes? Was it cleaned daily? Did multiple cats share a box?
List any animals your cat has been housed with. *
If housed with other animals, how did this cats do with them? *
How was your cat housed?*

Indoor onlyOutdoors onlyIndoors with acess to go outside
Please note any livestock your cat has been exposed to. N/A if none- *
Does the cat do any of the following? Check all that apply.
How would you describe this cat's usual behavior? Check all that apply.
Where does this cat like to sleep?
Please list anything we should be aware of with this cats medical history. Including ANY of the following medical concerns-Loss of appetite, Lethargy, Fever, Neurologic symptoms like circling, tremors, seizures, or blindness, Discharge from the nose/eyes, Severe depression, Rapid breathing, trouble breathing, Sneezing, Coughing, Diarrhea *
Please list any favorite toys/games this cat likes.*
Please list what food you have been feeding this cat and times.*
Please list any wonderful or special traits of your cat (s)*
Please upload pictures and Medical History (If any)

Cancelof
Should be Empty:

Cat Surrender Request

Owner Information

Feline Informtion