JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Owner Surrender Questionnaire
Complete this form for surrender of a cat to Pickens County Animal Shelter
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Cat's Name
*
Your answer
Sex of Cat
*
Female
Male
Spayed or Neutered
*
Yes
No
Age
*
Your answer
Why are you surrendering your pet?
*
Choose
Moving
Allergies
Behavior of pet
No time for pet
Cannot afford
Health of animal
Size of animal
Other
Where did you get your pet?
*
Choose
Adopted from a shelter or rescue
Stray
Breeder
Friend/Family
Gift
Is your pet current on vaccines?
*
Yes
No
Unknown
Name of vet? Please bring any medical records you may have.
Your answer
Does this pet have any medical conditions or previous injuries?
*
Yes
No
If yes to the last question, please explain
Your answer
Has this pet ever bitten a person or other animal?
*
Yes
No
If yes to the last question, please explain
Your answer
Where does your cat spend most of its time?
*
Indoors
Outside
Both
Where does your cat sleep?
*
Your answer
Does your cat use a litter box?
*
Yes
No
What size/type of litter box do you use?
*
Covered
Uncovered
Automatic
Other
Type of Litter? Check all that apply
*
Clay
Scoopable
Crystals
Scented
Unscented
Pine
Other:
Required
What type of food does this pet eat?
*
Dry
Canned
Dry and Canned
Special Diet (please specify in ADDITIONAL NOTES section below)
Has your cat ever been around other cats?
*
Yes
No
Has your cat ever been around dogs?
*
Yes
No
Has your cat ever lived in a home with children?
*
Yes
No
Does this pet have any behavior issues or destructive tendencies?
*
Yes
No
If yes to the last question, please explain
Your answer
Have you tried to rehome your pet?
*
Yes
No
How long have you been trying?
Your answer
Any other ADDITIONAL NOTES that you would like to share with the staff about your pet:
Your answer
Do you understand that when you surrender your pet to Pickens County Animal Shelter you will no longer have any rights to this pet and no further information regarding this pet will be given?
*
Yes
No
Do you understand that every effort will be made to place the animal(s). However, due to poor health, injuries beyond repair, and bad or unpredictable temperament, euthanasia is always a possibility.
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report