Intake/Surrender Application

Intake/Surrender Application

Generated with MOOJ Proforms Basic Version 1.3
* Required information.
Date *
Full Name *
Physical Address *
PO Box if you have one.
City, State, Zip *
Phone: Home, Cell, and Work *
Email
How did you hear about us? *
About Your Cat(s) Why do you need to surrender your cat? Please fill out one application per cat, if multiples. Moms with a litter of kittens may be submitted on one form. *
How long have you had the cat? *
What have you done so far to re-home your cat? *
If not your cat (a stray) – what have you done to locate the owner? *
Cat's Name
Gender of your cat. *
Male
Female
Spayed or Neutered *
Yes
No
Not sure (found stray)
Is the cat de-clawed? *
No
Front
All Four
Age of Cat (best guess if you are not certain) *
Type of cat breed (short/long-haired/special breed) Any coloring pattern/identifying marks *
You must provide a copy of your cat’s health record, including the following medical care - “Snap” testing for FeLV(Feline Leukemia) *
Yes
No
Not Sure
FVRCP vaccination *
Yes
No
Rabies vaccination *
Yes
No
If not tested or vaccinated – are you able to have this done?
Yes
No
Who is your veterinarian? *
Does the cat have any health issues or take any medications? Special food required? *
Describe the cat’s personality *
Does the cat get along with? *
Does the cat spend time outside? *
Does the cat have any litter box issues? *
If yes explain. *
Does the cat bite or scratch? *
Is there anything special about the cat that a new owner should know?
I certify that I understand the surrender requirements and that the information on this intake application is true and correct. I understand that Kitty City NM has the right to deny any application for intake that is not in the best interest of the shelter, based on principles, policies and standards. Signature. *
Photo of your cat if you have one.

LIKE US ON FACEBOOK!

You are here: Home Home Intake/Surrender Application