Surrender A CatPlease enable JavaScript in your browser to complete this form.Cat's Name *BreedAge *Sex *ColorThe 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 InfoPlease provide the following information regarding each veterinarian who has seen the Cat:Veterinarian 1Veterinarian Name/Practice *Veterinarian Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Veterinarian 2Veterinarian Name/PracticeVeterinarian AddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneVeterinarian 3Veterinarian Name/PracticeVeterinarian AddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhonePlease initial here to authorize us to contact the veterinarian(s) listed above and obtain information about the cat and the cat's care: *Clear SignatureHas the Cat ever lived with other animals? *YesNoIf yes, what other animals? *Has the Cat had any conflicts with any of these other animals? *YesNoIf yes, describe each of the conflicts that the Cat has had with these other animals: *Is the Cat good with other cats? *YesNoI don't knowPlease explain:Is the Cat good with dogs? *YesNoI don't knowPlease explain:Is the Cat good with children? *YesNoI don't knowPlease explain:Has the Cat ever had any conflicts with children? *YesNoI don't knowIf yes, describe each of the conflicts that the Cat has had with children:Where does the Cat spend most of his/her time? *Indoors onlyMostly indoorsIn a garageIn a barnMostly outsideAlways outsideIf indoors only, is the Cat confined to a certain area of the house?YesNoIf 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? *YesNoIf 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:WetDryBothWhat brand of food does the Cat prefer?Is the Cat declawed? YesNoIf yes, why?Does the Cat use his/her claws on furniture or drapes?YesNoDoes the Cat use a scratching post?YesNoIf 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? *YesNoIf 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? *YesNoIf 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? *YesNoIf yes, describe each of the incident(s) when the Cat scratched someone: *Has the Cat ever bitten anyone? *YesNoIf yes, describe each of the incident(s) when the Cat bit someone: *Is the Cat spayed or neutered? *YesNoAre the Cat's vaccinations up to date? *YesNoIf no, when was the Cat last vaccinated and what vaccinations did he or she receive?Has the Cat had any health issues? *YesNoIf yes, describe those health issues: *If yes, are those health issues resolved? *YesNoIs the Cat on any medications? *YesNoIf yes, please list those medications: *Do you use any form of flea control for the Cat?YesNoIf 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? *Affectionate AggressiveEnergeticFriendlyIndependentA lap cat OutgoingPlayful RelaxedShySlow to adjustTalkativeIs 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 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Signature Date *Signature (I agree to sign this document electronically) (use mouse to sign) *Clear SignatureSubmit