CAT SURRENDER Step 1 of 9 11% Date(Required) MM slash DD slash YYYY Owner Name(Required) First Last Phone Number(Required)Address(Required) Street Address Address Line 2 City Postal Code Pet's NameMicrochipAgeGenderVeterinarianPhone Number MedicalAre the cat’s vaccinations up to date? Yes No Is the cat spayed/neutered? Yes No Does the cat have any medical conditions? Yes No If yes, explainIs the cat currently given any medication? Yes No If yes, what medication?Has the cat been diagnosed with and/or treated for any of the following? respiratory infection allergies heart murmur tumors epilepsy or seizures organ failure urinary track infection thyroid disease diabetes other HomeIf the cat has lived with other cats, how did they interact? slept near each other played together urine/marking groomed each other ignored each other rough with each other fight with injuries fight without injuries caused your cat stress peacefully co-existed If the cat has lived with dogs, how did they interact? slept near each other played together cat tormented dog groomed each other ignored each other cat feared dog fight with injuries fight without injuries caused your cat stress peacefully co-existed urine/marking Has the cat regularly been around children? no 0-2 years 3-5 years 6-10 years 11-18 years How did the cat interact with children? cat avoided child child could pet cat played together cat hissed at child cat growled at child ignored each other HistoryAre you this cat’s first owner? Yes No How long have you owned?Is the cat declawed? front all not declawed If declawed, when was it done? as a kitten as an adult How did you obtain this pet(Required) pet store newspaper/internet rescue group stray breeder family/friend shelter other If rescue group or shelter, which one?Has the cat ever been used for breeding? Yes No Unknown Is the cat indoor only indoor/outdoor outdoor PersonalityHow would you describe the cat most of the time? friendly to family friendly to visitors shy to family shy to visitors quiet very active playful talkative lap cat a clown withdrawn affectionate fearful couch potato independent How does the cat like to play? plays gently, without teeth or claws likes to chase or pounce with toys likes to play hide and seek likes to play in or around water likes to play with dogs likes to play rough, may bite or scratch likes things that crackle, such as paper bags chases bugs or moths likes to learn tricks for treats not interested in play DietWhat brand of food is the cat currently eating?Type of food canned dry both What treats does the cat enjoy?How often is the cat fed? food always available designated mealtimes Litter box habitsDoes the cat always use the litter box?(Required) Yes No Partially How many litters boxes are in your home?Is the litter box(es) covered uncovered What type of litter is used unscented scented non-clumping yesterday's news crystals clumping clay other How often is the litter scooped? every day every few days weekly other Where is/are the litter box(es) in the house? SurrenderReason for surrender(Required)If surrender for litter box issues, please describe the accidents urinates outside the box defecates outside the box urinates on clothing/furniture sprays on walls When did the litter box accidents begin? past month past year ongoing Has the cat been to the veterinarian to rule out an underlying health issue? Yes No Can you pin point an event(s) that might influence or trigger inappropriate litter box use?Please describe measures you have taken to correct this problem new litter remove hood new box size other Has the cat ever bitten a person?(Required) Yes No Unknown Did the bite break skin(Required) Yes No If bite broke skin, date of bite(Required)If yes, was medical attention required?(Required) Yes No Details(Required)Does the cat have any bad or unusual habits? I hereby authorize that the following animal(s) are from Thunder Bay, Ontario District. I confirm that the animal is my legal property. By putting the animal into the Thunder Bay & District Humane Society’s shelter care, I am giving full custody to the shelter and therefore this cannot be reversed. By signing this, I am fully aware that I am surrendering my full legal rights to this animal. If found untruthful, I will be held liable to any fees accumulated and to an Animal Welfare investigation.Signature of Owner(Required)Print Name First Last If not owner of record, please state relationship to ownerI also authorize the TBDHS to receive all veterinary records from any of the veterinarians I have used. Signature(Required)CommentsThis field is for validation purposes and should be left unchanged.