Feline Surrender Form
Owner Information
Owner's Name
Home Phone:
Street Address:
City:
State:
Zip Code:
Cell Phone:
Daytime Phone:
Email Address:
Cat's Information
Name:
Breed:
Purbred or Mixed Breed?
Is the dog altered or intact?
Age:
Eye Color:
Coat Color/Length:
Personality, Quirks and Tricks - Please describe your cat with as much detail as possible.  Likes, dislikes, games, tricks and commands are great informaion.
How many hours a week is the cat used to spending alone?
Other
(please check all that apply)
Don't have enough room for the cat
Moving and can't take the cat with us
Too rough with our kids
Doesn't get  along with other animals
Cat is too hyper
Fond as a stray, but can't keep the cat
Don't have time for the cat
 
How long has the cat lived with you?
Detailed reasons for rehoming the cat:
Veterinary and Medical Information
Name of current vet:
No, past due on all vaccinations
Some:
Please enter the date of your cat's last rabies vaccinations:
Please enter the date of your cat's last FeLV/FIV vaccination:
Is your cat on flea and tick preventative? If so, which brand?
Vet's Office Address:
 
Yes, current on all vaccinations
Yes
No
Medical history - Please list any past injuries, surgeries, know medical conditions or allergies:
Is the cat microchipped?  If so, please list the microchip company:
 
Agreement to Provide Information
I agree to have my dog's vet reconrds faxed to 866-881-1080 for use by Lost Mittens Animal Rescue
I understand that my dog must be spayed or neutered and up to date on vaccination in order to participate in Lost Mittens Animal Rescue Owner Surrender program
I understand that I must provide photos of my cat.
Postal Mail - a LMAR volunteer will contact you to give you an address
Yes
No
Email - please list cat's name and the word photos in the subject line
I will provide photos of my cat via:
Temperment Information
By signing this document I am ensuring that the above information I provide is true and correct and that Lost Mittens Animal Rescue or it's agent will not be held liable or chargeable for any false informaiton, or any misrepresentations, that I have submitted on this form
I further agree and understand that Lost Mittens Animal Rescue will evaluate this cat to determine whether or not the cat being surrrendered will be considered "adoptable".  Placement is NOT guaranteed.
Signature:
Date:
Driver's License #:
Thank You!  You will be notified by Email
Cats's Gender:
Where did you get the dog?
Is the cat up to date on vaccinations?
You must be 18 years or older to sign this form
Reasons for rehoming the cat
Where does this cat live?
Vet's Phone:
Does your cat have a current Rabies vaccination?
How would your describe the cat's behavior around children?
Shy
Growls/hisses
Tolerant
Never been around children
Afraid
Playful
Friendly
How would you describe the cat's behavior around other animals?
Friendly
Afraid
Playful
Never been around children
Shy
Growls/hisses
Tolerant
How would you describe the cat's behavior around people he/she knows well?
Greets them at the door
Hides at first and then watches from afar
Hides at first, then friendly
Visitors would never even see the cat
Outgoing and friendly
Other
How does your cat react to visitors?
How would you describe your household?
Quiet
Noisy
Active
Average
Does this cat use a litter box?
Yes
No
Do you use clumping or clay litter?
If yes, please describe
Has this cat had accidents in the house?
Yes
No
Does this cat use a scratching post?
Yes
No
If yes, what kind
Does this cat like to be
Picked Up?
Sit in your lap?
Brushed?
Petted
Is there anywhere the cat does not like to be petted?
Does this cat have any bad habits the new owners should be aware of?
Does this cat have previous injuries or health problems?
Does this cat need a special diet or any medications?
What kind of food does the cat eat (dry/wet and brand)?
Is there anything else we should know about this cat?
Why are you giving up this cat?  Please be specific and honest
What type of home do you think would be best for this cat?
If the cat is determined to be un-adoptable by Lost Mittens Animal Rescue for any reason prior to placement, I agree to retrieve this animal within two (2) days following notification by Lost Mittens Animal Rescue.
Once we have all required information for the cat, it will be listed on Lost Mittens Animal Rescue website and on other pet sites such as Petfinder and 1-800-Save-A-Pet.
When the cat is rehomeds, will you provide permission in writing for the microchip company to change the information to that of the new owner?