Feline Relinquishment Form Date Owner Name Mailing Address (include city, state and zip code) Physical Address (include city, state and zip code) Home Phone Cell Phone Email Pet Name Age Weight Color Breed Gender Male Female Spayed / Neutered Yes No Up to date on vaccinations Yes No I'm not sure Is your pet microchipped? Yes No I'm not sure Last Vet Visit Name of vet Phone number of vet Address of vet Why are you giving this cat up? (be specific) Where did you get this cat? How long have you had this cat? Is this cat litter box trained? Yes No Where does this cat usually reside? Indoors only Indoor / Outdoor Outdoor Garage Other How many dogs do you have? None 1 2 3 4+ How many cats do you have? None 1 2 3 4+ How many other pets do you have? None 1 2 3 4+ Does this cat get along with kids? Yes No I'm not sure Behavior around kids? (check all that apply) Friendly Playful Tolerant Afraid Shy I'm not sure Does this cat get along with cats? Yes No I'm not sure Explain if needed Does this cat get along with dogs? Yes No I'm not sure Explain if needed Is the cat destructive in any way? Yes No If yes, explain Describe the cat's behavior most of the time Has this cat ever shown signs of aggression? Yes No If yes, explain Has this cat ever bit a person? Yes No If yes, explain Has this cat ever bit another animal? Yes No If yes, explain Where is the cat's favorite sleeping place? Does the cat have a favorite toy or game? Is this cat on a special diet? Yes No How many times per day is the cat fed? Once Twice Three times Free feed What time is feeding? (check all that apply) Morning Afternoon Early evening Free feed How much food is given each feeding? What brand of cat food do you feed? Wet or dry food? Wet Dry Both Anything else you would like to share to assist us in finding the perfect home for your pet? I, the undersigned, do hereby give my consent and permission for the Mountains’ Humane Society to take possession of the animal described herein for the purpose of placing it for adoption with another party. I further declare that I am the lawful owner of said animal and have disclosed the medical history and any behavioral abnormalities with Mountains’ Humane Society or its agent(s). I further affirm that I relinquish any further claim of said animal and release Mountains’ Humane Society, including its officers, directors, volunteers and employees of all liability involved in this transfer of ownership. I understand that there is a $100 cash per pet relinquishment fee that I will be responsible for. Signature(required) Date(required) Submit Δ
Mountains' Humane Society Pet Rescue