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Owner Surrender Form

Breed
Sex
Male
Female
Spayed/Neutered
Yes
No
Unsure
Health Condition
Good
Fair
Poor
Are vet records available
Yes
No
Unsure
Does your cat use the litterbox?
Yes
No
Sometimes
What type of litter does your cat use?
What type of litter box does your cat use?
What is your cats favorite toy?
How does your cat like to play?
What areas of your home did the cat have access to?
Where did your cat spend most of its time?
Does your cat have any of the following behavioral issues?(please check all that apply)

Authorization and Agreement:

Authorization to Surrender: I, the undersigned, authorize the surrender of ownership of the above-named cat to Old Acquaintance Rescue.


Release of Information: I understand that the information provided on this form may be used by Old Acquaintance Rescue for the purpose of rehoming the cat and may be shared with potential adopters.


Health Records Release: I authorize the release of any available health records and veterinary information related to the cat to Old Acquaintance Rescue.

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Date Signed
Month
Day
Year

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old black cat

781-214-1213

Groveland MA 01834

MA License #0753

shy gray cat

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