Owner Surrender Intake Request Form

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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

Country

*State/Province

Cat Information

Cat name

Gender

FemaleMaleUnknown

Breed

Age/Date of Birth

Where did you get the cat?

Why is the cat being surrendered?

Is the cat declawed?

YesNoUnknown

Is the cat microchipped? If so, what is the microchip number?

What vetting has the cat received? Specifically, is the cat spayed or neutered, has it received any vaccinations, has it had a recent fecal done to check for intestinal parasites, and has it been tested for FIV/FeLV (and if "yes", what were the results)?

List any known medical issue(s) the cat has or has had.

List all vets that have seen the cat.

Include clinic name, vet name, phone number, and address.

Name the vet records are under.

Has the cat ever bitten anyone? If yes, please list date(s) of bite(s) and brief description of the incident(ces).

Is the cat friendly with (check all that apply):

HumansCatsDogsChildren

Does this cat have any of the following behavioral issues (check all that apply):

Scratch thingsChew plantsChew electric cordsJumping up on counters, etcSprayingAggressionNot using litter boxOther

Please explain any behavioral issues where necessary. If you selected "Other", please explain. Please be honest, it will let us know what things we should work on with the cat.

Is this cat an indoor or outdoor cat, or both?

IndoorOutdoorBoth

General traits (check all that apply): 

HyperPlayfulShyMellowSubmissiveDominantEasy-goingGrouchyFearful

Other comments about the cat’s behavior?

Has the cat been outside or around other animals in the past month? If "yes", please elaborate.

What kind of socialization has the cat had? Specifically, can it be pet/handled/held by strangers?

Is the cat friendly with other cats?

Yes - Friendly with other catsNo - Not friendly with other catsIndifferent - Ignores other catsUnknown - Has not been around other cats

Brand/type of food the cat eats.

Please list any other information we should know about this cat.

Owner Confirmation & Info

What are your pronouns?

SHE/HER/HERSHE/HIM/HISTHEY/THEM/THEIRSPREFER NOT TO SAY

Acknowledgment

You certify that you are the rightful owner/keeper of the Animal(s).
You certify that the answers you provided above are truthful to the best of your knowledge.
You certify that the Animal(s) has not bitten or scratched a human or another animal within the past 10 days.

You acknowledge that IF your application is accepted:
You surrender to Felius Rescue any and all property rights to the Animal(s) and certify that no other person has a right of property to the Animal(s).
You understand that once you relinquish the Animal(s), the Animal(s) will not be available to be returned to you or anyone else.
You must pay a $25 per-cat surrender fee to Felius Rescue.

I AGREE TO THE TERMS ABOVE.

If you select "No" to these terms, your application will be rejected and unfortunately, Felius Rescue will be unable to assist with your request.

YesNo

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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