Surrender a Cat form

First name

Last name

Address

Mobile Number

Email

Vets Name and Address

Cat Name

Cat Age

Cat Sex

Male

Female

Unknown

Has the cat been neutered?

Yes

No

Unsure

Has the cat been microchipped?

Yes

No

Unsure

If Yes, what's the microchip number?

Has the cat been vaccinated?

Yes

No

Unsure

If Yes, please upload a picture of the vaccination certificate

Has the cat been Treated with Flea and Worm Treatment?

Flea Only

Worm Only

Both

Not been treated

Date of last Flea or Worm Treatment

Does the cat have any medical issues we need to be aware of?

Does the Cat have any Dietary Requirements?

Does the cat have any allergies?

Is there any medication to hand over? If yes, please give details

Is the cat a house cat or outdoor cat?

House Cat

Outdoor Cat

Unknown

Select the following that the cat has lived with:

Dogs

Cats

Children

Other

Where did you originally get the cat from?

How long has the cat lived with you?

Reason for Surrender

I herby relinquish full ownership of the said animal to the care of Easterleigh Animal Sanctuary. The information I have supplied is correct to the best of my knowledge. If handing over the animal on behalf of someone else I have received full permission to do so (in this case please write the full details of the registered owner on the bottom of this form). I will cooperate and provide further information if the charity should require it in the future.

Signature

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If signed on behalf of somebody add their name here