The Sanctuary...

Cat Surrender Application

Please provide as much information as possible to the following questions. This will help us to provide for the cat, and place him or her in the most appropriate home. Your answers to these questions will not determine whether or not we will accept the cat. Please answer honestly as this will help us properly place the cat.

To download a pdf version of this form and fill it out by hand click here

General Information
* Name of Cat:
Cat's Date of Birth:
* Cat's Gender:
* Cat's Breed:
* Where did you obtain the cat?
If other, explain:
If the cat was a stray, where was it picked up?
* Did you contact Animal Control?
* How long have you had the cat?
Health and Well-Being
Please note that we will need a copy of all veterinary records for the cat.
Please describe the condition and health of the cat:
Has the cat been spayed/neutered?
* Has the cat received vaccinations?
If yes, which vaccinations were last received?
On what date were they given?
* Has the cat been tested for Feline Leukemia?
If yes, when was it tested?
What were the results?
* Has the cat been tested for Feline Immunodeficiency Virus?
If yes, when was it tested?
What were the results?
Personality and Behavior
In your own words, describe the personality of the cat.:
What is your cat afraid of or uncomfortable with?
What, if any, body parts is the cat sensitive about being handled?
Does the cat bite?
What is the best quality of the cat?
What is the worst quality of the cat?
Any additional information about the cat's personality or habits that you would like us to know:
Behavior With Other Animals
* Has the cat lived with other animals?
If yes, who?
What is their behavior towards them?
What does the cat do when it sees cats outside the house?
What does the cat do when it sees dogs outside the house?
Has the cat ever fought with other cats?
Has the cat ever injured other cats?
Tolerance of People
Describe the cat's behavior with people in the following situations
Visitors in the home:
When the cat is bathed:
When the cat's nails are clipped or ears are cleaned:
Does it like sitting on people's laps?
Does it like to be pet?
Does it like to be picked up?
Tolerance of/experience with children
* Has the cat lived with children?
If yes, what ages?
What genders:
How does the cat behave with visiting children?
How does the cat react in the following situations involving children
Screaming/crying:
Touching/petting:
Pulling on cat's tail/ears/fur:
When a child is running around the house:
When a child hugs them:
When a child runs towards them:
When you pick up the child:
Aggression Towards People
Has the cat ever done any of the following? If yes please give a description of the behavior.
* Growled:
If yes, explain:
* Hissed:
If yes, explain:
* Clawed/scratched:
If yes, explain:
* Nipped:
If yes, explain:
* Bitten:
If yes, explain:
Routine
What kind of food do you feed the cat?
How often do you feed it?
Where does the cat live?
What kinds of toys does the cat like to play with?
* Has the cat had problems with scratching furniture?
* Was a litterbox provided in the house?
What type and size of litterbox was provided? (i.e. covered, tall box, small, low box):
What kind of litter was used?
* What brand and kind of litter was used?
How deep was the litter in the box?
Did you use litterbox liners?
How many boxes did you have?
How many cats used these boxes?
How many litterbox locations were provided?
Where were they located?
How often was the litterbox cleaned?
Have there been any recent changes to the litter or the boxes you have used?
Has the cat ever urinated or defecated outside the box?
If yes, is the cat currently urinating/defecating outside the box?
If so, where is it eliminating?
How long has the elimination outside the box been occurring?
Have you taken it to the veterinarian to have a urinalysis and bloodwork completed?
What have you done to try to stop the inappropriate elimination?
Reason for Surrendering
* Why are you surrendering the cat?
* We appreciate your commintment to our purpose with the release of this/these animal(s). With each animal surrendered, HEA incurs additional expenses to provide proper care for the animal. Please select the amount you would like to donate:
If other please designate the amount:
* Your Name:
Organization (if applicable):
* Street Address:
* City:
* State/Province/Province:
* Zip Code:
Home Phone:
Work Phone:
Time you can be reached:
Fax Number:
* Email Address:


* Digital Signature:
* Initials:
* Date:

The Sanctuary...

General Information

Health and Well-Being

Please note that we will need a copy of all veterinary records for the cat.

Personality and Behavior

Behavior With Other Animals

Tolerance of People

Describe the cat's behavior with people in the following situations

Tolerance of/experience with children

How does the cat react in the following situations involving children

Aggression Towards People

Has the cat ever done any of the following? If yes please give a description of the behavior.

Routine

Reason for Surrendering