Release of Ownership to lookwhatthecatbroughtin.org Questionnaire and Agreement

Date:___________________

 

Cat’s name and description:

Name: ___________Gender________ Altered: (check one)Yes[ ] or No[ ]

Why do you need to surrender this cat?

If your cat is having litter box issues, please describe:

If your cat is having litter box issues or other behavior issues, have you taken her or him to your veterinarian? (check one) Yes[ ] or No[ ]

 

Is he or she current on vaccinations? (check one)Yes[ ] or No[ ]

If not, can you have him or her vaccinated for rabies, distemper combo and tested for FIV/FeLV in the next two-week period?

How many other cats or kittens are in your home?___ List below:

Name Age Gender Altered Yes/No

________ _____ ________ _____________

________ _____ ________ _____________

________ _____ ________ _____________

________ _____ ________ _____________

________ _____ ________ _____________

________ _____ ________ _____________

________ _____ ________ _____________

________ _____ ________ _____________

I am being truthful in all answers given in the above questionnaire.

Signed:_____________________________Owner

Name:_____________________ Phone:_________________

 

Agreement:

I being the rightful owner of this(these) animals(s), am authorized and hereby relinquish all rights to this (these) animal(s) to lookwhatthecatbroughtin.org, further, to the best of my knowledge this(these) animal(s) has(have) not bitten anyone within the past ten days.

I give permission for my prior vet

___________________________________(name and phone)

to release all medical records of the above described animal(s) to lookwhatthecatbroughtin.org or their designated veterinary medical provider.

I agree to cooperate with lookwhatthecatbroughtin.org in having all unaltered cats listed in question 6. altered. Further, in consideration for acceptance of these cats, I also agree that I will not give away any kittens to anyone other than look what the cat brought in. I will not accept any unaltered cats into my household for one year following the date of this agreement.

 

Signed:_____________________________Owner

Name:_____________________ Phone:_________________

(Please Print)

Address:_______________________________

Street City State Zip

Date:_______________________________

 

 

 

This agreement is not valid until signed by a representative of Lookwhatthecatbroughtin.

Signed:_____________________________Lookwhatthecatbroughtin

Date:________________________________________