Cat Owner Surrender Form

Collects the owner's details and the cat's behavioral and health history when a cat is being surrendered to a shelter, rescue, or veterinary clinic.

Use this template

Name

Nombre

Apellido

Phone Number

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Cat's Name

Breed

Sex of the cat

Age of the cat

Spayed/Neutered

Health Condition

Healthy Minor Health Issues Chronic Illness Unknown

Are vaccination records available?

Picture of the cat

Max 10 MB per file

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?

What is your cat's favorite toy? (please select all that apply)

How does your cat like to play? (please select all that apply)

What areas of your home did the cat have access to? (please check all that apply)

Where did your cat spend most of its time? (please check all that apply)

Does your cat have any of the following behavioral issues? (please check all that apply)

Scratching Furniture Aggression Excessive Meowing Litter Box Avoidance None

Explain your answer of other here.

Owner's Statement

Signature

Sign here

Date Signed

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