Feline Surrender ApplicationPet Owner InformationPet Owner Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone (please include area code)*Have you adopted from, donated to, or surrendered another animal to Wayside Waifs in the past?*-YesNoPlease list any other name(s) you may have used, if applicable (i.e. maiden name, aliases, etc.)*Pet's Description/InformationPet's name:*Nickname(s) for pet:*Pet's original name (if adopted from Wayside):*Pet's age:*Breed:*Gender:*-MaleFemaleIs this pet spayed or neutered?*-YesNoUnknownDoes this pet have a microchip?*-YesNoI don't knowHow much does this pet currently weigh?*Describe this pet's color/markings:*Where did you get this cat?* Wayside Waifs Another shelter/rescue Friend/Family Pet Shop Breeder Found as a Stray Born at Home Online/Internet Gift Other 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?*-Yes - Completely Declawed (all 4 paws)Yes - Front Declaw Only (has back/rear claws)NoThis 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 HabitsHow many litterboxes are in the house?*Litterbox description (check all that apply):*-CoveredUncoveredTop-entryOtherDescribe "other" litterboxes:*How often is the litterbox scooped?*-DailyEvery few daysWeeklyRarelyNeverWhat type of litter is used?*Did this cat use the litterbox?*-Yes - All of the timeSometimes - Had occasional accidentsNoSprays UrineOtherPlease 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?*-YesNoWhat was the diagnosis/outcome?*Pet's Medical InformationName of animal clinic you use:*Primary care veterinarian's name:*Did this cat receive annual examinations?*-YesNoUnknownIs this cat current on vaccinations?*-YesNoUnknownDoes your cat require special handling at the vet?*-YesNoUnknown (has not been to a veterinarian)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?*-YesNoN/A (Has never been to a veterinarian)Please describe the reason(s) for those visits:*Does this cat have any medical problems or previous injuries that require special attention?*-YesNoPlease explain (ex. type of injury or diagnosis, current treatments, etc.)*Is this cat on a special/prescription diet?*-YesNoPlease 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)?*-YesNoSometimesPlease list all medications/supplements that this cat is currently taking and the dosing instructions:*Pet's Behavior InformationHas this cat ever bitten a person?*-YesNoPlease describe what happened before, during, and after the bite:*Has this cat bitten a person in the last 10 days?*-YesNoDid the bite break the person's skin?*-YesNoHave you reported the bite to animal control?*-YesNoOn what date did the bite occur?* MM slash DD slash YYYY Has this cat ever bitten another animal?*-YesNoPlease 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?*-YesNoPlease 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?*-YesNoDescribe 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 InformationHas anyone ever threatened to harm/harmed your pet(s)?*-YesNoHas anyone ever threatened to harm/harmed you?*-YesNoDo you feel safe in your home?*-YesNoPlease upload (1) image of your pet. Image should be in focus and show the animals face and body.Max. file size: 50 MB.Upload imageEmailThis field is for validation purposes and should be left unchanged.