Feline Surrender Form - Upper Credit Humane Society

Owner Information

Name *

First Last

Address *

Street Address Address Line 2 City Province Postal Code

Home Phone

Mobile Phone

Email *

Cat Information

Name *

Age *

Breed *

Colour *

Gender *

Male
Female

Spayed or Neutered *

Yes
No

Is your cat decalwed? *

No
Yes (front claws only)
Yes (all claws)

Is the cat kept: *

Indoors
Outdoors
Both

How long have you had your cat? *

Where did you get your cat? *

Reason for surrender: *

Cat Preferences and Behaviour

What type of scratching post does your cat prefer? *

Check all that apply.

Does your cat get along with

Dogs
Cats
Children

Check all that apply. Leave unchecked if uncertain.

Indicate your cat’s preference for the following:

Head/neck petting *

Enjoys
Tolerates
Dislikes
Will bite/scratch

Lower back petting *

Enjoys
Tolerates
Dislikes
Will bite/scratch

Touching tail *

Enjoys
Tolerates
Dislikes
Will bite/scratch

Touching paws *

Enjoys
Tolerates
Dislikes
Will bite/scratch

Touching stomach *

Enjoys
Tolerates
Dislikes
Will bite/scratch

Being picked up/held by owners *

Enjoys
Tolerates
Dislikes
Will bite/scratch

Being picked up/held by strangers *

Enjoys
Tolerates
Dislikes
Will bite/scratch

Being brushed *

Enjoys
Tolerates
Dislikes
Will bite/scratch

Does your cat like to play? *

Yes
No

What type of play does your cat enjoy?

Chasing things on the floor
Chasing things in the air
Playing with owner
Playing independently
Likes to play rough with people
Other

Check all that apply.

Health/Medical

Has your cat ever been to a veterinarian? *

Yes
No

Has your cat been vaccinated? *

Yes
No

If Yes, then when?

What is the name of the vet clinic visited?

Clinic phone number

Has your cat had any medical issues in the past? *

Yes
No

If yes, please describe:

Does your cat currently have any medical issues? *

Yes
No

If yes, please describe:

Has your cat ever urinated or defecated outside the litter box? *

Yes
No

Has your cat ever scratched or bitten anyone? *

Yes
No

Other

Is there anything else you would like to tell us about your cat?