Surrender Form for We Care Animal Rescue

Name of Animal:*

Approximate Weight:

Approximate Age (years/months/weeks)*

Male or Female*

Is the cat/kitten*

Spayed/Neutered*

If yes, date of spay/neuter:

Please select one of the following:*

Is your cat:*

Is your cat declawed?*

Your Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

E-mail Address

Any previous vet care? If yes, please provide the name of vet and services.

Why are you looking to find a new home for your cat?*

If we could help you resolve the issue, would you consider keeping your cat?*

Is there anything about your cat's health you feel we should know?*

In your own words, please describe your cat's personality:*

Relinquishing your pet to an animal shelter is a last resort. What have you done to try to rehome your cat?*

How long have you had your cat and where did you get them?*

Has your cat lived with other animals? What kind?*

Describe your cat's behavior around other cats:*

On average, how long is your cat left alone each day?*

Does your cat have any issues with being left alone?*

Does your cat like to sit/sleep on your lap?*

Does your cat like to be petted? Please explain if not.*

What might cause your cat to scratch, hiss, or bite?*

What type of litter box do you use (covered, uncovered)?*

Does your cat ever eliminate outside of the litter box?*

If yes, how long have you been experiencing this issue?

Is this animal up to date on vaccines/yearly exams?*

Name of your cat's veterinarian:*

Does your cat require any sedatives or special considerations for vet visits?*

Does this cat have any special needs or require medication?*

Has this cat ever been diagnosed or treated for a medical condition, such as ringworm, diabetes, URI, dental issues, kidney issues, urinary blockages, or cancer? Please specify.*

Is this cat on a special diet?

Is this cat accustomed to bathing, brushing, and/or nail trims?*

What brand of food does your cat currently eat?*

How often a day does your cat eat?*

Is this animal friendly and able to be handled?*

Does anyone else have ownership rights to this animal?*

Has this animal bitten anyone in the last 10 days?*

Signature and date*

By signing this form, you certify that you are the owner of this animal and all information provided is truthful. You have reviewed all options and choose to surrender your pet to We Care Animal Rescue.

Signature and date

You also verify that this animal is up to date on vaccinations and that you can provide medical/vet records, which is required by We Care Animal Rescue to go forward with a surrender. By leaving this blank, you are stating the animal is not vaccinated or does not have medical records.

Signature and date*

We request a $40.00 surrender fee to help assist us with the cost of care. If you are financially unable to pay the fee, please speak with a WCAR Coordinator.

Consent*

I hereby surrender the above described animal to We Care Animal Rescue. Upon surrender of this animal, I release any claim on this animal and relinquish all rights with respect to the animal. I understand the animal will not be returned to me.

Submission of this form does not commit We Care Animal Rescue to take-in the animal. We are a small non-profit with space and resource considerations, and often cannot take in an animal immediately. We will inform you as soon as possible if we are able to intake the animal. We will consider animals with certain chronic conditions and minor health issues with good prognosis. In cases of surrender for hardship due to health care costs and complex health care needs, we will review and give special consideration, including the capacity of healthy appropriate shelter space and personnel available, ability to manage the health care needs (both in direct care and cost). Due to limitations of specialized space and medical personnel, extreme health cases may not be suitable for our sanctuary. We provide medical care, but we are not a veterinary hospital or specialized medical center.

By signing this form you relinquish all ownership rights to this animal. The animal becomes the property of We Care Animal Rescue. By submitting this form with my name and date, I am legally acknowledging these terms.

If the animal is an owner surrender and is the offspring from another pet the surrenderer owns, the surrenderer must have that pet spayed before or have an appointment for spay before We Care Animal Rescue agrees to accept pet into our program.

I understand that animals must pass a temperament test and vet exam, as well as be up-to-date on vaccines, spayed/neutered, and combo tested prior to surrender.

We collect demographic information to assist us when applying for grants. If you would like to participate, please fill out the following survey.

What is your age?

18-24
25-34
34-44
45-54
over 54

Which gender do you most identify with?

Male
Female
Transgender
Other

What best describes your ethnicity (select all that apply)?

Latino or Hispanic
African-American
Asian
Native American
Pacific Islander
Caucasian
Other
Prefer not to say

What is your marital status?

Married
Domestic Partnership
Divorced
Separated
Widowed
Unmarried/Never married

Untitled

First Choice
Second Choice
Third Choice

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Surrender Form for We Care Animal Rescue

Cat Surrender Form

We collect demographic information to assist us when applying for grants. If you would like to participate, please fill out the following survey.