Surrender A Cat

Cat's Name *

Breed

Age *

Sex *

Color

The information requested below must be filled in completely and accurately.

Why are you giving up this Cat (hereinafter referred to as “the Cat”)? *

How long has the Cat lived with you? *

In how many other homes has the Cat lived? *

From where did you get the Cat? *

Veterinarian Info

Please provide the following information regarding each veterinarian who has seen the Cat:

Veterinarian 1

Veterinarian Name/Practice *

Veterinarian Address *

Address Line 1

City

State

Zip Code

Phone *

Veterinarian 2

Veterinarian Name/Practice

Veterinarian Address

Address Line 1

City

State

Zip Code

Phone

Veterinarian 3

Veterinarian Name/Practice

Veterinarian Address

Address Line 1

City

State

Zip Code

Phone

Please initial here to authorize us to contact the veterinarian(s) listed above and obtain information about the cat and the cat's care: *

Has the Cat ever lived with other animals? *

Yes
No

If yes, what other animals? *

Has the Cat had any conflicts with any of these other animals? *

Yes
No

If yes, describe each of the conflicts that the Cat has had with these other animals: *

Is the Cat good with other cats? *

Yes
No
I don't know

Please explain:

Is the Cat good with dogs? *

Yes
No
I don't know

Please explain:

Is the Cat good with children? *

Yes
No
I don't know

Please explain:

Has the Cat ever had any conflicts with children? *

Yes
No
I don't know

If yes, describe each of the conflicts that the Cat has had with children:

Where does the Cat spend most of his/her time? *

If indoors only, is the Cat confined to a certain area of the house?

Yes
No

If yes, what area of the house is the Cat confined to?

Where is the Cat’s litter box kept?

How many cats share the litter box?

Does the Cat urinate or defecate outside the litter box? *

Yes
No

If yes, how often? *

If yes, provide an example of when the Cat defecates outside of the litter box:

What kind of litter do you use for the Cat?

How often do you change the litter?

What type of food does the Cat eat:

Wet
Dry
Both

What brand of food does the Cat prefer?

Is the Cat declawed?

Yes
No

If yes, why?

Does the Cat use his/her claws on furniture or drapes?

Yes
No

Does the Cat use a scratching post?

Yes
No

If yes, what type?

If yes, where in your house is the scratching post kept?

How often is the Cat brushed or groomed?

Describe any problems with grooming:

How often does the Cat get hairballs?

Does the Cat spray? *

Yes
No

If yes, how often does the Cat spray? *

If yes, when and where does the Cat spray? *

Have you ever consulted a trainer or behaviorist regarding any issues concerning the Cat? *

Yes
No

If yes, describe the issue(s) that were addressed and the results:

What form of discipline or correction do you use with the Cat?

How does the Cat react to this?

Has the Cat ever scratched anyone? *

Yes
No

If yes, describe each of the incident(s) when the Cat scratched someone: *

Has the Cat ever bitten anyone? *

Yes
No

If yes, describe each of the incident(s) when the Cat bit someone: *

Is the Cat spayed or neutered? *

Yes
No

Are the Cat's vaccinations up to date? *

Yes
No

If no, when was the Cat last vaccinated and what vaccinations did he or she receive?

Has the Cat had any health issues? *

Yes
No

If yes, describe those health issues: *

If yes, are those health issues resolved? *

Yes
No

Is the Cat on any medications? *

Yes
No

If yes, please list those medications: *

Do you use any form of flea control for the Cat?

Yes
No

If yes, what form of flea control?

Describe the Cat’s idea of a perfect day:

Please check each of the following that describes the Cat’s behavior/personality? *

Is there anything else we should know about the Cat?

Please email us a photo of the Cat at ilovepets@theanimalhavenct.org and provide the name of Cat in the text of your email.

I hereby certify the truth and accuracy of all the information that I have provided above. I also hereby certify that I have the legal right to surrender the Cat to The Animal Haven, Inc. (“Animal Haven”) and that no one else has any right to or interest in the Cat. If The Animal Haven agrees to take in the Cat (which The Animal Haven may or may not do in its sole discretion), I surrender to The Animal Haven all my rights to and interest in the Cat. I understand that if The Animal Haven takes in the Cat, The Animal Haven will try to find the Cat a new home and that I will have no input whatsoever regarding any new home or potential new home found for the Cat. I also understand that if, in the opinion of The Animal Haven, the Cat exhibits any behaviors or has any characteristics that will make it difficult for The Animal Haven to adopt out the Cat to a new home, The Animal Haven may notify me and request that I take the Cat back. If I am so notified by The Animal Haven, I will come to the shelter, pick up the Cat, and take the Cat back home with me.

Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Signature Date *

Signature (I agree to sign this document electronically) (use mouse to sign) *

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Veterinarian Info

Veterinarian 1

Veterinarian 2

Veterinarian 3

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