Lawrence County Humane Society
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Owner Surrender Form for Cats
Please answer all questions honestly and completely. This is for your cat’s benefit as well as ours. We want to find the best match possible for your cat. Being dishonest or omitting information only hurts your cat.
Are you the owner?
Yes
No
Owner Info
Name
*
First
Last
Email Address
*
Phone Number
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Are you a resident of Lawrence County, PA?
Yes
No
Where did you acquire the cat from?
*
Why are you wanting to surrender the cat?
Cat Info
Name
*
Age
Breed
Color
Male/Female
Male
Female
Spayed/Neutered
Yes
No
Declawed
Yes
No
Is the cat indoor or outdoor?
Indoor
Outdoor
Does the cat have any health issues or allergies?
Yes
No
If yes, please describe
Does the cat require medications, special diet, and/or frequent vet visits?
Yes
No
If yes, please describe
Temperament
Has the cat ever bitten anyone?
Yes
No
If yes, please explain what caused the bite and the severity
*
Does the cat live and/or have lived with the following:
Other cats
Dogs
Children
Farm animals
Other small animals
If yes, how did they do with them?
Fears
Please check any of the following that your cat has issues with or fear of:
Grooming
Nail trim
Men
Fireworks
Storms
Strangers
Vet visits
Other
Please explain the behavior with the fear:
Does your cat have any behavioral issues with:
Not using the litter box
Doesn't like picked up
Are they destructive?
*
Yes
No
Veterinarian's Name
*
Veterinarian's Phone Number
*
By signing below, I agree that the above information is true to the best of my knowledge:
Signature
*
Date
*
MM slash DD slash YYYY
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