Surrender Request Form

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Please fill out this form to the best of your ability. Your answers will help gather information to see if we are able to accept your cat into our shelter. Our intake team will reach out to gather additional information after receiving this form. HART of Maine cannot guarantee any intake and submission of this form does not guarantee an intake for your pet. HART schedules appointments for each intake and cannot accept same-day walk ins. If you have any questions, please reach out to our intake team, intake@hartofme.org
Is this an urgent request? If yes, please explain.
Name *
Street Address *
City, State *
Zipcode *
Email *
Confirm email
Home Phone
Cell Phone *
When do you need to surrender your pet by? *
Please explain why you need to surrender your cat: *
This section is all about your cat. Please provide as many details as possible.
Cat's Name *
Age *
Gender *
Color	Black Black and White Black and White - Spotted Black and White - Tuxedo Black with White Black with White Socks Blue Blue Point Brown (chocolate) Brown (chocolate) and White Buff Buff and White Buff with White Calico Calico, Dilute Chocolate Chocolate Point Cinnamon Cream Cream Point Flame Point Gray Gray and White Gray w/ White Lilac Point Lynx Point Orange Orange and White Orange w/ White Other Red Ruddy Seal Point Smoke Snow Shoe Tabby, Brown and White Tabby, Brown-Dark Tabby, Brown-Light Tabby, Brown w/ White Tabby, Buff Tabby, Buff and White Tabby, Buff w/ White Tabby, Gray Tabby, Gray and White Tabby, Gray w/ White Tabby, Orange Tabby, Orange and White Tabby, Orange w/ White Tabby, Patch Tabby, Patch and White Tabby, Patch, Dilute Tabby, Patch, Dilute w/ white Tabby, Patch w/ White Tabby, Silver Tabby, Silver and White Tabby, Silver w/ White Tabby, Smoke Tabby, Smoke & White Tortie Tortie, Dilute Tortie, Dilute w/ White Tortie Point Tortie w/ White Unknown White White with Black White with Brown White with Gray White with Orange
Breed
Is your cat microchipped? *	NoYes
Is your cat spayed or neutered? *	NoYes
Is your cat indoor or outdoor? Please note: HART cannot house outdoor cats *	Indoor Outdoor Both Barn
Is your cat declawed? *	NoYes
Are you the owner of this cat? *	NoYes
Is this a HART return? *	NoYes
Where did you originally get this cat? *
Have you contacted the original owner or shelter? *
How long have you had this cat? *
This section asks questions about your cats medical history. Please provide as many details as possible.
Has your cat been to the vet in the past year? *	NoYes
Please list the name of any veterinarian or veterinary clinics your cat has ever been to.
Is your pet up to date on vaccinations? *	NoYes
Does your cat have any diagnosed medical conditions? *	NoYes
Does this cat have any suspected medical needs? *	NoYes
If yes, please explain: *
If yes, please explain:
Does your pet take any prescription medications or supplements, or eat a special diet? *	NoYes
If yes, please list them:
This section asks questions about your cats behavior history. Please provide as many details as possible.
Does your cat get along with other cats? *	NoYes
Has your cat lived with other animals? *	NoYes
If yes, please list reaction to other pets:
Please list the ages of people your cat has lived with: *
Please describe your pets personality: *
Does your cat have any known behavioral concerns? *	NoYes
If yes, please explain: *
Please select any of these behaviors your cat has expressed:	Scratching Furniture Chews Plants Chews Electrical Cords Chews Fabric or Cloths Jumps on Counters Spraying or Marking Inappropriate Urination Escapes Climbs Curtains Bites or Swats Other
Has your cat bitten or scratched anyone in the last 14 days? *	NoYes
If yes, please explain the circumstances:
Does your cat use the litterbox consistently? *	NoYes
If no, please explain: *
Is there anything else you would like to share about your cat?
By submitting this form, I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this Animal Surrender Form, hereinafter referred to as “the cat.” I certify that all information about the cat in this form is accurate, to the best of my knowledge. I understand that by submitting this form, I am not guaranteed that HART will accept the intake of my cat. HART reserves the right to refuse intake for any animal for any reason.
Signature *	Clear