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Cat/Kitten Surrender Request 
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Name - (First & Last name)  *
Email Address *
Full Address  *
Phone Number *
Cats name *
Date of Birth / Approximate Age  *
Describe your cats colors and markings *
Breed *
Gender *
Has your cat been spayed / neutered, when did this take place? Do you have the certificate?  *
Has your cat been microchipped or tattooed? Please provide this number if known *
How did you acquire this animal?  *
Does your cat have any sensitivities or allergies? List both food and environment  *
What type of food is your cat eating? (wet, dry, brand and flavor) *
Does your cat have any behavioral problems? *
Please tell us the reason(s) you wish to surrender your cat *
Upon surrender, we will ask for your animals full medical file to be submitted so that our veterinarians have the proper history and information to make the best decisions they can for this animal. By completing this agreement, you are agreeing to submit or transfer ownership of these records to Alberta Homeward Housecats Rescue Bureau. 
I agree to the above terms and will submit or transfer all medical records upon surrender *
Required
Who is your cats current veterinarian? *
Has your cat seen their vet in the last year? *
Does your cat have any health concerns, ongoing medical treatments (include medication) or concerns that we should know about? *
Are all vaccinations up to date and certificates available for validation? *
Please give us a detailed description of your cats personality and demeanor *
To your knowledge, has this animal bitten or shown potential to bite in the past? If yes, what were the triggers? *
Is the cat litter trained? *
If you selected "partially" or "no", how often are they eliminating outside of the litter box? *
Where does your cat stay when you aren't around? (in the house, garage, outside, etc) *
Is your cat restricted from anywhere in the house, and if yes, why?  *
Do you have other pets in the home? How does this cat interact with them? Please share any concerns, aggressions or fears so we can best match them with a foster environment.  *
Do you have children in the home? How does this cat interact with them?  Please share any concerns, aggressions or fears so we can best match them with a foster environment.  *
My cat is afraid of ( select all that apply)
Will you be surrendering the cat with any of their items? (collar, carrier, food, dishes, scratching post, toys, etc) *
Is there any other information about your cat that hasn't been covered anywhere else in this form that we should know about? 
Please read the following statements and check off EACH item to signify agreement with the statement. Your electronic signature will follow to end the document and final consent. 
Check all that apply
I (We) agree that the information that I (we) have provided to Alberta Homeward Hound (Housecats) Rescue Bureau is correct and true, to the best of my(our) knowledge.
I (We) have not falsified my (our) responses and I (we) understand that my (our) application can be denied if it is determined that I (we) have not been truthful in
this application. I (we) certify that I (we) am (are) the true and rightful owners of this cat. He/she has not been stolen or surrendered against the true and rightful owners wishes.
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Todays Date 
Full Legal Name of Owner(s)
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