First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Are you the legal owner of this animal?

Why are you looking to surrender your animals?*

How soon are you looking to surrender your animal(s)?*

Did you adopt the animal(s) you want to surrender from our organization?

Did you adopt the animal you wish to surrender from a rescue or organization that requires you to return the animal to them?

How long have you owned the animal(s) you would like to surrender?*

List each animal you are surrendering with as much information as possible.*

Is the animal you wish to surrender good with children?*

Is the animal you wish to surrender good with dogs?

Is the animal you wish to surrender good with other cats?

Is the animal you wish to surrender litter box trained?

Are there any behavioral concerns with the animal(s) you are surrendering?*

Do you have vet records for this animal? Please provide all records upon surrendering the animal*
Choose one: Yes No

When was the last appointment the animal(s) you wish to surrender had at the vet?*

What heartworm and flea prevention is the animal(s) you wish to surrender currently taking? When was the last dose?*

Does the pet you are surrendering have any medical conditions including special diets?*

Are all animals being surrendered current on all vaccines?*

Are all animals being surrendered spayed/neutered?

Is your animal microchipped?

Would you be willing to foster your animal in your home while we place it for adoption?

Would you be willing to make a donation to the rescue for the care of the pet you are surrendering?

Additional Information:

I am the owner/party that found this animal and hereby relinquish all present and future rights and claims to this animal and his/her possessions transferred with him/her to Cat Tail Corner Inc. I certify that I have fully informed the individuals/organization above of all known or suspected problems and concerns about this animal. Further, I have indicated all information possible to ensure the animal has continued happiness and welfare. I understand that I may not be provided with information about this animal’s whereabouts. To the best of my knowledge, this animal has no defects or problems that would make it unsuitable as a family pet. Please Initial in agreement*

I certify that the information entered on this applicant is true. Enter your name and date*