Owner Surrender ApplicationPaul Klein2017-01-22T07:25:38-07:00Step 1 of 8 - Contact Information0%EntryID **********Please note that we are currently only considering intakes of felines at this time. Proof of residency and ownership must be presented at the time of surrender. Surrender fees are to be paid by cash, check or online. Surrender fees are to be paid only after the animal has been approved to enter the rescue and has passed a medical/behavioral evaluation If more than one cat is to be surrendered, please fill out application for each cat ********** Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Enter Email Confirm Email Cat's age*Please enter a number from 1 to 10.Proof of Ownership*How did you obtain this cat?*Reason for surrender*What other outlets have you contacted or tried?*Do you wish to be contacted as a last resort if we can't find a suitable home or placement for this pet?*YesNoWhat is your timeline for your surrender?*Are you able to foster this cat until he/she finds a home?*YesNoVeterinarianName*Phone*When was the last time your cat saw the veterinarian?* Cat DetailsName*Breed*Gender*FemaleMaleDescription (color)*Is this cat spayed/neutered?*YesNoIs this cat declawed?*YesNoHas this cat been tested for Feline Leukemia and Feline AIDS?*YesNoDate of last vaccinations*Is this cat microchipped?*YesNo General BehaviorCheck all that best describe your cat* Active Talkative Friendly Submissive Shy Affectionate Independent Dominant AggressiveIs your cat afraid of anything?*YesNoIf Yes, please explain*Is your cat litter-box trained?*YesNoDoes your cat ever choose to eliminate outside the liter-box?*YesNoDoes the cat sometimes urinate inappropriately?*YesNoIf Yes, does your cat urinate*Horizontally (on floors, flat surfaces)Vertically (on walls, on sides of furniture)BothDoes the cat sometimes defecate inappropriately?*YesNoIf Yes, where or on what is the cat eliminating?*If Yes, how long has this been going on?*How often does the cat eliminate inappropriately?*Have you changed the litter type?*YesNoHave you moved the location of the liter-box?*YesNoHas there been an addition to your family (dog, cat, child)?*YesNoIf Yes, please explain*Has there been a major change in your family (move, marriage, new roommate, death)?*YesNoIf Yes, please explain*Is the cat ever destructive?*YesNoIf Yes, specifically when and to what?*Does the cat ever behave aggressively when touched on certain parts of the body?*YesNoIf Yes, specifically when and to what?*How does the cat respond to being brushed, bathed and having toenails trimmed?*EnjoysToleratesDislikesBiting HistoryHas the cat ever bitten anyone?*YesNoIf Yes, when did the bite(s) occur?*Did it break the skin?*YesNoHow many times has the cat bitten?*What were the circumstances of the bite(s)?* Behavior with OthersHas the cat lived with children?*YesNoIf Yes, how recently?*What ages were the children?*How did the cat respond to the children?* Plays with Tolerates Hides from Fights withHow did the children play with the cat?* Fetch String Toys Wrestling with hands OtherHas the cat lived with other cats?*YesNoIf Yes, please indicate the age and gender of each other cat*AgeGender What was the cat's response to the other cat(s)?* Plays with Tolerates Hides from Fights withHas the cat lived with dogs?*YesNoIf Yes, please indicate the age and gender of each other dog*AgeGenderBreed What was the cat's response to the dog(s)?* Plays with Tolerates Hides from Fights withHas the cat lived with any animals other than dogs or cats?*YesNoIf Yes, please specify what type of animal* Living EnvironmentHow many hours per day is the cat indoors?*How many hours per day is the cat outdoors?*Does the cat have access to a cat door?*YesNoHow many hours per day is the cat without humans?*Does the cat have a scratching post?*YesNoIf Yes, what kind of post?*WoodRopeCarpetCardboardOtherDoes the cat use the scratching post?*YesNoWhere does the cat sleep?*IndoorsOutdoors Does the cat have any chronic medical problems?*YesNoIf Yes, pelase explain in detail*Is the cat ill, injured, or on any special diet or medications?*YesNoIf Yes, please explain*Addional Comments and OpinionsIn your own words, what would be the ideal home for your cat?*How do you believe your cat would react to staying in the cat adoption center at a location like Petsmart or Petco?*Do you have objections to your cat being housed in this kind of a location in order to be adopted?*YesNoAdditional comments or information you'd like to share about the cat* Legal DisclaimerI understand that if my cat was accepted into Saving One Life Rescue that I will relinquish all rights to my cat. I certify that the information I have submitted is true and accurate to the best of my knowledgeI have read, reviewed and agree to all stipulations described above*YesNoSubmit FormCaptcha This iframe contains the logic required to handle Ajax powered Gravity Forms.