Surrender or Return

Surrender or Return - Cat

Animals brought to HSMC, who have been in a household and are being surrendered

Surrender / Return Cat Please be as specific as possible. Thank you for your open and honest answers. Your donation to cover costs while in our care, is greatly appreciated. Please let us know the dollar amount you would like to donate.

Today's Date:
Owner first name: *
Last name: *
Surrendered by if different than owner:
Address: *
City: *
State: *
Zip: *
Cell/phone: *
Email:
Cat’s Name *
Sex *	Female Male
Age: *
Breed *
Altered: *
Altered date:
Why are you surrendering: *
How long has the cat lived with you: *
How many owners has this cat had: *
Share 3 things you like about your cat and want others to know: *
Any special medical or dietary needs (include medications and food given): *
Any previous health issues or injuries (surgeries, seizures, fractures, allergies, etc):
Current on Vaccinations - PLEASE PROVIDE COPY OF MOST RECENT VET RECORDS: *
Date last Vet visit, Vet's name/phone #: *
Has your cat ever bitten a person: *
How many people and how many times: *
Did the bite:	Draw blood Leave a mark Bruise
Explain who was bitten, when and where was bite located: *
Specifics of what provoked the incident: *
Situations or items that cause your cat to hide, bite, hiss, lunge, or otherwise act aggressively towards people: *	Food Toys Restraint Hugging/Kissing Disturbed when sleeping Stranger entering home Reaching for cat Brushing/bathing Nail trimming other N/A
Describe severity of behavior for each situation indicated above: *
Situations or items that cause your cat to hide, bite or act aggressively toward other dogs or cats. Select all that apply: *	Food Toys Attention from Owner Dog or cat entering home Other N/A
Explain the severity of behavior for each situation indicated above:
Does cat have litter box issues: *
If yes, what type of litter box issues:
What type of box, litter, how many boxes you have & how many other cats:
Number and ages of children under 18 your cat has lived with or regularly visited:
How did they interact:
Other animals your cat has lived with and how did they interact: *
List things cat is afraid of:
Is cat allowed on the furniture:
Where does cat sleep:
Where does your cat predominantly live:	Inside Outside Both
One average, how many hours a day is your cat alone: *
Where do you leave your cat when no one is home:	Outside Free inside Confined to a room In a crate Other
Check all words describing your cat: *	Calm Friendly Energetic Independent Playful Fearful/shy Anxious Confident Aggressive
When left alone, check all that apply: *	Destroy household items Urinate/defecate Chews/scratches N/A
Does it matter how long you are gone:
Favorite toys and games
What would you change about your cat:
What do you feed your cat / How often / How much: *
Information you wish to share about your cat:
I, owner of said animal relinquish all rights of ownership, understand that Helping Strays personnel are under no obligation to release any information regarding the disposition of said animal, and give shelter permission to contact any veterinarians or animal care facility regarding the medical records of said animal. Owner Signature: *
To the knowledge of the owner, said animal has not bitten anyone. Owner Signature: *