Feline Surrender Application_24Pet 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)*Are you the owner of the cat? If not, what's your relationship with the owner?*Have you adopted from, donated to, or surrendered another animal to Wayside Waifs in the past?*-YesNoPet's Description/InformationPet's name:*Pet's age:*Breed:*Gender:*-MaleFemaleIs this pet spayed or neutered?*-YesNoUnknownDescribe this pet's color/markings:*Is this cat declawed?*-NoFront DeclawAll 4 declawUnknownWhere did you get this cat?* Found as a Stray Breeder or Pet Store Family Friend/Acquaintance/Co-worker/Neighbor Adopted from Wayside Waifs Adopted from another shelter/rescue Born at Home Gift Internet Listing If you chose "Adopted from another shelter/rescue" please list where this cat was adopted from.Have you tried reaching out to that shelter?YesNoHow long have you owned this cat?*What is the main reason why you are surrendering?* Permanent life change Short-term life change Owner death Can't afford Owner/household factors No time/overwhelmed Housing Behavior per owner Owner intended euthanasia Are you interested in troubleshooting options to keep your pet in the home?*YesNoMaybeHow long can you continue to safely care for the pet?*Pet's Litterbox HabitsWhat type/brand of litter is used/preferred by your cat?*Does this cat ALWAYS use the litterbox? If yes, skip to Medical Questions.*YesNoIf no, does your cat require special litter, placement, cleanliness, or other circumstances to use the litterbox consistently?Please describe the accidents (ex. urination or defecation or both, where did the accidents occur, etc.):Have you had this cat evaluated by a medical professional for these issues? If yes, please describe tests, treatments, and if treatment, and if treatment was successful.Does this cat prefer to go to the bathroom outside and will house-soil if not permitted outside? Yes No N/A Medical QuestionsName of veterinary clinic you use:*Does your pet have any ongoing or current medical concerns?*YesNoUnknownIf yes, please describe:Has this cat been diagnosed for anything by a veterinarian?*-YesNoUnknownIf yes, please describe:Is your pet taking any medications and/or on a special diet?* Yes No Unknown If yes, please list medications or prescribed special diet:If your cat has been seen at a vet, what do they do for medical handling such as blood draws, receiving vaccines, and just generally being handled?*Has your vet ever spoken to you about your cat needing to take medication prior to visiting? Yes No N/A Pet's Behavior InformationHow would you describe your pet's personality? (gentle, friendly, nervous, etc.)*Throughout your cat's day they are:*Indoor onlyOutdoor onlyIndoor and OutdoorYour cat has lived with:* Men Women Children (age 0-3) Children (age 3-6) Children (age 6-12) Teenagers (12-18) Dogs Cats Small mammals (rabbits, ferrets, guinea pigs, etc.) Domestic birds Farm animals Has this cat ever bitten a person? If no, skip next 5 questions.*-YesNoUnknownDid the bite draw blood?-YesNoIf yes, has this cat bitten a person in the last 10 days?-YesNoPlease describe the incident(s) using as much detail as possible:Date of most recent incident: Month Day Year Was the bite a result of playful behavior? Yes No Unknown Has the cat ever bitten another animal? If no, skip next 3 questions.*-YesNoUnknownDate of most recent incident: MM slash DD slash YYYY Species of the other animal (dog/cat/etc.):Did the bite draw blood?-YesNoWas the bite a result of playful behavior? Yes No Unknown Please describe what happened before, during, and after the bite:What is your 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 None of the above How does your cat react to new/unfamiliar people?*Does the cat have trouble being in confined places like carriers/kennels? If yes, please describe:*Personality, Misc. InformationThis information is optional to submit this application, but if your pet is accepted we will ask for these questions to be completed. What are some awesome things about your pet?What are some of your cat's nicknames?Does your pet prefer certain kinds of food or treats?Describe your cat's eating habits. (ex: free fed dry food, social eater, cannot free feed, etc.)Does your cat prefer to perch on high places or low places?In an ideal world, what level of exercise/playtime would your cat enjoy getting every day?Does your pet have any bad habits?What are some things your cat LIKES?What are som things your cat DISLIKES?If your cat plays with toys, what are their favorites?Is there anything else you want us to know about your pet?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 imageNameThis field is for validation purposes and should be left unchanged.
