Meriden Humane Society Feline (Cat) Request to Surrender Form

Please fill out this form to add your feline to our feline intake waiting list.

Owner Information
Who is requesting to surrender?

First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Cell Phone
Home Phone
Email Address

Feline Information

Species *
Feline Name *
Gender *
Breed (type the first few letters to narrow down list) *
Feline Age (Ex: 1yr, 4mo) *
Approximate Weight Range
Is your feline microchipped? *
Is your feline spayed or neutered? *
Is your feline declawed? *

Up to date on vaccinations:

Rabies? *
FVRCP? *
List any other vaccination/s:

Are you able to provide vet records to support vetting history? (Please Note: In order to expedite the surrender process, please contact your vet and give them permission to provide vetting information on the animal in question) *
Vet Information (Name and Phone#) *
How long have you had your feline? Ex. 3yr 3mo *
Did you adopt your cat from the Meriden Humane Society? *
Did you adopt your cat from a rescue or breeder? *
If not from MHS, please include Organization Name and State
Have you contacted the rescue or breeder? MHS requires you to contact the original rescue or breeder first and provide documentation of why the animal cannot return to them.
What was the date of contact and the rescue/breeder's response? If they are not able to accept the cat back, please indicate their reason.
Does your feline have any medical issues? *
If yes, what is his/her condition(s)?

Feline Behavior

Is your feline good with other cats? *
Is your feline good with children? *
Is your feline good with dogs? *
Does your feline like to be pet? *
Does your feline like to be picked up and held? *
Is there any time your feline is aggressive or any other behaviors we should know about? *

Why are you choosing to surrender your feline? *

By signing below you affirm that all the information you have provided above is correct to the best of your knowledge and that you are the legal owner of the animals who's information you have provided above.
Sign Here: Use mouse as pen (or finger if using a mobile device): *
Please Note: Filling out this form does not guarantee we will be able to take your feline. We often have a wait list and recommend you reach out to as many rescues as possible. As of 12/1/2018: MHS requests a $50 feline surrender donation.