Humane Society of Kodiak Feline Surrender Profile & Release Form

Answering these questions honestly will not stop HSK from admitting your animal but will ensure that we are able to provide the correct care for your animal. Please help us to help your animal.

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Owner Information
Person Providing Information *
First name *
Surname *
Address *
Phone number *
Email address *
Pet Information
Animal Name *
Breed *
Pet color/markings *
Age and/or date of birth *
Sex *
Has the animal been neutered? *
Microchipped? *
Please explain why you are surrendering your pet *
How long have you owned this pet? *
Where did you get your pet? *
If you said other, please explain
Pet Health Information
Are there records of your pet at the Kodiak Vet Clinic? *
If you answered no, does your pet have records at another vet? If so, please list name and number
Is the animal up to date with its annual vaccinations? *
Does your cat have any present or past medical conditons? *
If yes, please describe pets health condition and any medications pet currently requires
What type of food does your cat eat? - brands of food, scraps, dry or canned, flavor. Any dislikes? *
How often is your cat fed? *
How does your cat react to grooming? *
How does your cat behave at the vet? *
Home Information & Social Behavior
Where does your cat spend most his/her time? *
If you said other, please describe
Do you leave your cat alone for any period of time? If so, how long for and do you have concerns about them being on their own? *
Is the cat litter box trained? *
Does your cat have accidents in the house? *
What type of litter does your cat prefer? *
Has the your pet lived with other cats? *
Describe your cat's behavior around other cats (check all that apply) *
Would you recommend placing this cat in a home with other cats? *
Has your cat lived with dogs? *
Describe your cat's behavior around dogs (check all that apply) *
Would you recommend placing this cat in a home with dogs? *
If so, please specify the species
Has your pet lived with animals other than cats and dogs? *
Has your cat lived with children? *
If so, please specify ages
If no, has the pet met children and what was his/her reaction?
What age groups were any children met?
Is your cat used to men and women? *
How would you describe your pet's personality? (check all that apply) *
How vocal is your pet? *
How active is your pet? *
Does your pet have any bad habits? *
Is your pet frightened of anything (i.e. fireworks, vacuum, etc)? *
Would you describe your animal as a gentle player or does he/she like "rough" play? Describe your animal's play activity, eg. favourite game, favourite toy, etc. *
Is your pet allowed on the furniture or in your bed? *
Has the animal ever been destructive in the house? Please describe
Where does the animal sleep? *
How does your pet travel? *
How does your pet react when he/she has done something wrong? How do you "tell him off"?
Has your pet bitten any person with the last 14 days? *
I acknowledge my understanding of, and agreement with the following terms and conditions that govern the relinquishment of the above described pet
If the animal is of suitable health and temperament, it will be placed in the Humane Society's adoption program: *
The Kodiak Animal Shelter is a "no kill" shelter for "friendly, adoptable animals. If this animal does not pass the health and/or behavioral screening at any time during the pet's stay, we may have to euthanize. This means that the animal will be put to death in the most humane way possible. It is extremely rare that we have to euthanize a pet, but in extreme circumstances the health and quality of life of the pet is taken seriously: * *
I understand that I can contact the Kodiak Animal Shelter at any time to check the status of the pet that is being surrendered. I also understand that it is my responsibility to update my contact information with the Kodiak Animal Shelter.
I herby release the Humane Society of Kodiak and its employees, staff, agents and/or representatives from any claims or demands that I have, or my have, that (a) may be connected with the above described pet; (b) may arise out of the Humane Society's care of the above described pet; or (c) may arise out of the Humane Society euthanizing this pet.
Signature *

Humane Society of Kodiak Feline Surrender Profile & Release Form

Owner Information

Pet Information

Pet Health Information

Home Information & Social Behavior

I acknowledge my understanding of, and agreement with the following terms and conditions that govern the relinquishment of the above described pet

I understand that I can contact the Kodiak Animal Shelter at any time to check the status of the pet that is being surrendered. I also understand that it is my responsibility to update my contact information with the Kodiak Animal Shelter.