Feline Surrender | Welcome to Wayside Waifs

Feline Surrender Application

Pet Owner Information

Pet Owner Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone (please include area code)*

Have you adopted from, donated to, or surrendered another animal to Wayside Waifs in the past?*

Please list any other name(s) you may have used, if applicable (i.e. maiden name, aliases, etc.)*

Pet's Description/Information

Pet's name:*

Nickname(s) for pet:*

Pet's original name (if adopted from Wayside):*

Pet's age:*

Breed:*

Gender:*

Is this pet spayed or neutered?*

Does this pet have a microchip?*

How much does this pet currently weigh?*

Describe this pet's color/markings:*

Where did you get this cat?*

What is the name of the shelter/rescue where you adopted this cat?*

If you selected other, please describe:*

How long have you owned this cat?*

Is this cat declawed?*

This cat has lived with:*

Women
Men
Children
Cats
Dogs
Other animals

Please explain your selections above (including ages of children, and a detailed description of all other animals this cat has lived with):*

If you ARE NOT the 1st/original owner of this cat, what additional information did the previous owner give you (behavior or medical history)?*

Why are you surrendering this cat?*

Pet's Litterbox Habits

How many litterboxes are in the house?*

Litterbox description (check all that apply):*

Describe "other" litterboxes:*

How often is the litterbox scooped?*

What type of litter is used?*

Did this cat use the litterbox?*

Please describe the accidents (ex. urination or defecation or both, where did the accidents occur, etc.):*

When did the litterbox/elimination problems begin?*

Can you pinpoint an event (ex. a move, new pet, change of litter type, new baby, etc.) that may have triggered these litterbox issues?*

Please describe what measures you've taken to attempt to correct this issue:*

Has this cat been examined by a veterinarian to rule-out medical causes for these issues?*

What was the diagnosis/outcome?*

Pet's Medical Information

Name of animal clinic you use:*

Primary care veterinarian's name:*

Did this cat receive annual examinations?*

Is this cat current on vaccinations?*

Does your cat require special handling at the vet?*

Please describe experience at vet (ex. must be sedated, tries to bite/scratch, fearful, anxious)*

Has this cat seen a vet for anything other than routine vaccinations?*

Please describe the reason(s) for those visits:*

Does this cat have any medical problems or previous injuries that require special attention?*

Please explain (ex. type of injury or diagnosis, current treatments, etc.)*

Is this cat on a special/prescription diet?*

Please list the diagnosis/reason for the special diet:*

Describe this cat's diet (such as brand of food, wet or dry, favorite flavors, etc.):*

Describe meal-time (i.e. how often, time of day, fed alone or around other animals/people):*

Would you describe this cat as a "social eater" (i.e. likes to be around people/animals when eating)?*

Please list all medications/supplements that this cat is currently taking and the dosing instructions:*

Pet's Behavior Information

Has this cat ever bitten a person?*

Please describe what happened before, during, and after the bite:*

Has this cat bitten a person in the last 10 days?*

Did the bite break the person's skin?*

Have you reported the bite to animal control?*

On what date did the bite occur?*

Has this cat ever bitten another animal?*

Please describe what happened before, during, and after the bite:*

This cat is:*

Indoors Only
Indoor/Outdoor
Outdoors Only
Outdoor Feral Cat
Indoors (but confined to one room)
Other

Describe "other" environment:*

Describe your cat's reaction to women in the household:*

Describe your cat's reaction to men in the household:*

Describe your cat's reaction to children in the household:*

Describe your cat's reaction to other cats in the household:*

Describe your cat's reaction to dogs in the household:*

Describe your cat's reaction to strangers visiting the home:*

Describe your cat's reaction to nail trims:*

Please describe a typical day/routine for this cat:*

How would you describe this cat's personality?*

What is this cat's favorite style of play? (Select all that apply)*

Very gentle
Likes toys
Plays with other animals
Very energetic/rambunctious
Can get nippy when playing
Doesn't play much
Other

Please describe "other" play style:*

When is this cat most active?*

Morning
Mid-day
Evening
Middle of the night

Does this cat have any behaviors that other adopters should be aware of?*

Does this cat have any areas of sensitivity where they do not like to be touched?*

Please describe area(s) of sensitivity and cat's reaction:*

Please list any behavioral and/or medical concerns that you have not been able to address (with a veterinarian, trainer, or other professional):*

Have you taken any steps to remedy the reason(s) that are causing you to give up this pet?*

Describe the steps taken here:*

What training, commands, or special skills does your cat know?*

We understand how difficult it is to surrender a beloved pet. What do you envision their "perfect home" to be like?*

Household Safety/Wellness Information

Has anyone ever threatened to harm/harmed your pet(s)?*

Has anyone ever threatened to harm/harmed you?*

Do you feel safe in your home?*

Please upload (1) image of your pet. Image should be in focus and show the animals face and body.

Max. file size: 50 MB.

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Name

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