Cat Surrender Application

If you think that surrendering your cat to MHHS is the best option for your family, please fill out the form below and a staff member will review your case. Please note that we cannot accept pets that have significant medical issues or behavioral issues into our adoptions program.

To help offset the substantial cost of caring for and placing your pet, there is a surrender fee of $50 per transaction (all animals, same day, same owner). We do offer income-based assistance with this fee, on a case-by-case basis.

Client Information

First and Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone

Ext:

Alternate Phone

Ext:

Medical History

Veterinarian Name

Clinic/Practice Name

Clinic/Practice Phone Number

Is this cat up-to-date with a rabies vaccination?

Yes

Date of last rabies vaccination:

Which type of rabies vaccination did this cat receive?

1-year

3-year

Unsure

Please list any medication and dosage this cat currently receives (including supplements):

Has this cat ever had serious medical issues?

Yes

If yes, please explain:

Describe this cat's behavior while at the veterinarian (ex. is medication needed):

Home Environment

This information will help us determine what type of home will be best for this animal in the future.

Diet and Feeding

What brand of cat food is fed to this cat?

Please choose what type of food this cat eats:

Dry

Wet

Both

How much and at what time(s) is this cat fed?

What is this cat’s favorite treat?

Environmental Background

Describe a typical 24-hour day in this cat’s life:

Does this cat go outside?

Yes

Not on purpose

How often and how far from your home does this cat go?

How does this cat like to play?

What is this cat’s favorite type of toy?

Is this cat fully litterbox trained?

Yes

Does this cat ever have accidents outside of the box?

Yes

Does this cat (check all that apply):

Urinate

Defecate

How often does this cat have accidents in the home?

What type of litter does this cat prefer?

What type of litterbox does this cat prefer?

Acknowledgement

Check this box in acknowledgement of the $50 surrender fee to help offset care of this cat if accepted into the Adoption Program.

Client Information

Cat Information

Medical History

Home Environment

Who Lives In The Home?

Pet Background

Diet and Feeding

Environmental Background

Behavior Background

Acknowledgement

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