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Apply to Surrender a Cat

1Current Owner Information

2Cat Basics

3Routine

4Disposition

5Medical

6Authorization

First Name*
Last Name*
eMail Address
eMail Address Confirm eMail Address
Street Address*
Suite or Unit Number
City*
State/Province*
Select State
ZIP/Postal Code*
0 of 6 max characters
Country
United States
- Phone
History
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Cat Default Status: Submitted
- Are you the legal owner of the cat?*
  - Yes
  - No
- Please Explain*
- Are you the only owner of the cat?*
  - Yes
  - No
- Please Provide Other Owner's Name:
- Other Owner's Phone #
When Did You Get The Cat? (approximate if necessary)
Month
Day
Year
How Long Have You Had This Cat?
Select Length of Time
- How Was The Cat Obtained?
  Select Method
- Please Explain
- Breeder's Name (if Known)
- Have They Been Notified?
  - Yes
  - No
- Why Not?
- Owner of Cat's Sire (If Known)
- Why Are You Giving Up The Cat?*
- Please Explain
- Please Explain The Behavior Issues
- Please Explain The Health Issues
- Please Explain Care Needed
- How Many Homes Has This Cat Had?
  Select Number
- Are you prepared to transfer registration to the Rescue on or prior to the surrender of the cat?*
  - Yes
  - No
Veterinarian Information
Do You Have a Veterinarian?
- Yes
- No
Name of Clinic
Name of Vet
Street Address
Suite or Unit Number
City
State
ZIP
Phone

- Cat's Name*
- Cat's Registered Name (If Purebred)
- Cat's Registration Number (If Known)
- Primary Breed
- Breed Name
- Secondary Breed
- Breed Name
- Primary Color
- Which Color?*
- Secondary Color
- Which Color?*
Gender*
- Male
- Female
Cat's Date of Birth (If Known)
Month
Day
Year
Weight
Energy Level*
- Good With Kids?*
- Good With Dogs?*
- Please Explain*
- Good With Cats?*
- Good With Small Animals?
Good With Livestock?
Is Cat Trained?
- Are There Any Special Needs (Medical)?
  - Yes
  - No
- What Special Needs(Medical)?
  Select All That Apply
- Are There Any Special Needs (Emotional)?
  - Yes
  - No
- What Special Needs (Emotional)?
  Select All That Apply
Description of the Cat
Featured Image
Accepted file types: jpg, jpeg, png, gif.
750 Wide x 750 High in Pixels
Additional Photos of The Cat
Drop files here or

Accepted file types: jpg, gif, png, jpeg, Max. file size: 1 MB, Max. files: 3.
Upload Photos of the Cat (minimum of 3 - include one head shot, one full body) and 750 Wide x 750 High in Pixels

Eating
- How Often Is The Cat Fed?
- Does Cat Eat Wet Or Dry Food (Or Both)?
- What Type Of Wet Food Does The Cat Eat?*
- How Much Wet Food Does The Cat Eat?*
- What Type Of Dry Food Does The Cat Eat?*
- How Much Dry Food Does The Cat Eat?*
- What Type Of Wet Food Does The Cat Eat?*
- How Much Wet Food Does The Cat Eat?*
- What Type Of Dry Food Does The Cat Eat?*
- How Much Dry Food Does The Cat Eat?*
- What Ingredients?*
- How Much?*
Is Cat A Good Eater?
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Does Cat Steal Food From Table/Counters?
Sleeping
- Which Room Does Cat Normally Sleep In At Night?
  Select All That Apply
- Please Describe*
- What Does Cat Use For A Bed?
  Select All That Apply
- Please Describe*
- Is Cat Allowed On Furniture?
Grooming
- How Often is Cat Bathed?
- Please Describe:
- Does Cat Mind Baths/Grooming
- Does Cat Mind Toenails Clipped
- Does Cat Mind Ears Cleaned
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How Often is Cat Groomed?
Please Describe:

Cat & People
- Is Cat A One Person Cat?
- Does Cat Like Men?
- Please Explain*
- Please Explain*
- Does Cat Like Women?
- Please Explain*
- Please Explain*
- Does Cat Prefer Men?
- Please Explain*
- Does Cat Prefer Women?
- Please Explain*
- Does Cat Jump On People?
Is Cat Friendly With Strangers?
Is Cat Good With Other Animals?
Is Cat Good With Kids?
Does Cat Like Kids Under 6?
Does Cat Like Kids 6-10?
Does Cat Like Kids Over 10?
Is Cat Good with Male Cats?
Is Cat Good with Female Cats?
Other Behaviors/Traits Not Covered
Is there anything else you would like to let us know about the Cat's disposition?
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Training
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Does Cat Know Basic Commands?
Select All That Apply
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Is Cat Obedience Trained?
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Is Cat House Trained?
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Is Cat Crate Trained?
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Is Cat Leash Trained?
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How Does Cat React on Walks?
Select All That Apply
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Does Cat Know How To Use A Doggie Door?
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Does Cat Have Occasional Accidents?
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Does Cat Tear/Chew Furniture Or Carpet?
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Can Cat Be Left Uncrated?
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Does Cat Dig?
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Does Cat Know How To Swim?
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Does Cat Jump Fences?
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Does Cat Escape?
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Does Cat Ride Well In The Car?
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Barking
- This field is hidden when viewing the form
  Does Cat Bark At Noises?
- This field is hidden when viewing the form
  Does Cat Bark At Someone At The Door?
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  Does Cat Bark Excessively?
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Fear & Agression
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  Does Cat Exhibit Submissive Behavior?
- Please Describe*
- Please Describe*
- This field is hidden when viewing the form
  Does Cat Exhibit Aggressive Behavior?
- Please Describe*
- Please Describe*
- This field is hidden when viewing the form
  Does Cat Guard Food?
- Please Describe*
- Please Describe*
- This field is hidden when viewing the form
  Does Cat Guard Other Resources (Toys, People, etc.)?
- Please Describe*
- Please Describe*
- This field is hidden when viewing the form
  Is Cat Shy?
- Please Describe*
- Please Describe*
- This field is hidden when viewing the form
  Is Cat Fearful Of Strange Noises/Storms?
- Please Describe*
- Please Describe*
- This field is hidden when viewing the form
  Has Cat Ever Bitten Anyone?
- Please Explain*
- This field is hidden when viewing the form
  Has Cat Otherwise Attacked Anyone?
- Please Explain*
- This field is hidden when viewing the form
  Has Cat Attacked Another Animal (Cat, Cat or Other)?
- Please Explain*
- This field is hidden when viewing the form
  Is there anything else you would like to let us know about the cat's disposition?

Medical: MicroChip Information
- Is Cat MicroChipped?
  - Yes
  - No
  - Unknown
- MicroChip Company (If Known):
- Other Company Name:*
- MicroChip Number (If Known):
Exam Dates
- Last Heartworm Test
- Heartworm Results
  - Positive
  - Negative
- Next Heartworm Test
- Last 4DX
- Heartworm
  - Positive
  - Negative
- Lyme
  - Positive
  - Negative
- Ehrlichia Canis
  - Positive
  - Negative
- Ehrlichia Ewingi
  - Positive
  - Negative
- Anaplasma Phagocytophilum
  - Positive
  - Negative
- Anaplasma Platys
  - Positive
  - Negative
- Next 4DX
- Last Fecal
- Clostridium
  - Positive
  - Negative
  - Not Tested
- Coccidia
  - Positive
  - Negative
  - Not Tested
- Giardia
  - Positive
  - Negative
  - Not Tested
- Roundworms
  - Positive
  - Negative
  - Not Tested
- Tapeworms
  - Positive
  - Negative
  - Not Tested
- Whipworms
  - Positive
  - Negative
  - Not Tested
- Parasites
  - Positive
  - Negative
  - Not Tested
- Bacteria
  - Positive
  - Negative
  - Not Tested
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  Date 1
  Dates medication given/started for positive Fecal Flotation Test result(s) above or for prophylactic deworming of negative fecal result.*
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  Date 2
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  Date 3
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  Next Deworming Treatment
- Next Fecal
- LAST FeLV
- FeLV Results
  - Positive
  - Negative
- NEXT FeLV
- LAST FIV
- FIV Results
  - Positive
  - Negative
- NEXT FIV
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Flea & Tick
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Medication
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LAST DATE
Date Flea/Tick Preventative Given
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NEXT DATE
Next Flea/Tick Treatment (Flea/Tick preventatives are due once a month unless the cat is on Bravecto which is given every 3 months.)
Spay Neuter
Has The Cat Been Spayed/Neutered?
- Yes
- No
Name of Vet Verifying Surgery
How Was it Verified?
Please Describe
Expected Date
Please Explain Why Not
Please Describe
Medical & Dental Issues
Past Medical Issues
Past Dental Issues
Known Allergies
Add Allergies

Notes
Is there anything else you would like to let us know?
In your opinion, what would be the best type of home situation for this cat?
Signature
Authorization: I hereby represent and warrant each of the following: (a) that I am the rightful owner/keeper/caretaker/custodian of the cat (b) that I have authority to convey, surrender and relinquish the cat, (c) that I am hereby willfully surrendering and releasing any and all of my property rights to the cat, (d) that no other person has a right of ownership or property to the cat, (e) that upon surrender the cat may not be returned to me. I have read and understand the terms of this Surrender From.*
- Yes
Name
This field is for validation purposes and should be left unchanged.

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