PROGRAMS & SERVICES / ANIMAL SURRENDER

Cat Surrender Form

Tell us about your cat so we can understand their needs and help support their next chapter.

Pet owner with animal and compassionate support

Before a Surrender Can Be Considered

You must have the knowledge and consent of all members of the household, be 18 years of age, have valid I.D. and a current address, and understand that the Northumberland Humane Society has the right to refuse your application.

Tell Us About Your Cat

Before you send this form

About surrender fees. The Northumberland Humane Society is a charitable community resource, dedicated to protecting and providing temporary shelter and comfort to all animals in need and promoting adoption and rehoming for abused, abandoned, neglected, and unwanted companion animals. It relies solely on donations, bequests, and its own fundraising efforts for its very survival. In order for its doors to remain open the continued support of the community is essential.

Why do we ask for a surrender fee? Your surrender fee goes towards providing food and general care; veterinary care; spaying/neutering; vaccinations, microchipping and deworming treatment; and maintenance of the shelter.

Release of medical information and veterinary records. I hereby request that the veterinarian named in this form release any information pertaining to the animal(s) named in this form contained in the veterinary records at the clinic named in this form to the Northumberland Humane Society. This request and authorization is limited to the above-noted agency. This shall be your good and sufficient authority for doing so.

Cat's name *

Owner Information

Name *

Phone number(s) *

Address *

Apt #

City *

Postal Code *

Email *

General Information

Gender Male Female Unknown

Spayed/Neutered Yes No Unknown

Age

Breed

Colour

Identification details

Identification Tattoo Microchip None / Unknown

Recent photo of your cat (optional)

JPG, PNG or WebP, up to 2 MB. Large photos are shrunk for you before they are sent.

History

Why are you surrendering this cat? *

If we could help you resolve this issue, would you be interested in keeping the cat?

How long have you owned this cat?

Where did you acquire this cat?

Has your cat ever bitten anyone before? If yes, under what circumstances and when?

If yes, is the incident documented with By-law, Animal Control or Public Health?

Medical

What veterinary clinic does the cat visit?

Has this cat seen a veterinarian at least once per year? Yes No Unknown

Is this cat currently up to date with vaccines? Yes No Unknown

Date of last vaccination

Has this cat ever required medical surgery? Yes No Unknown

If yes, please explain (surgery)

Has this cat ever been diagnosed and/or treated for any medical problems? Yes No Unknown

If yes, please explain (medical problems)

Is your cat currently receiving any medication?

Dietary Habits

Is your cat on a prescription diet? Yes No

What BRAND of food are you currently feeding your cat?

Which does your cat eat? Please select all that apply Dry only Canned only Combination of both People food

How is your cat fed? Food always available Designated mealtimes

How often and how much is your cat fed?

Training / Litter Box Habits

Is your cat litter trained? Yes No

If not, how often are there accidents?

When did the accidents begin?

Please describe the accidents: Urinates outside box Defecates outside box Urinates on clothing/furniture Sprays

Other / measures you have taken to correct this problem

Has your cat been to the vet to rule out infection or another underlying health issue? Yes No Unknown

How many litter boxes are in the home?

How often is/are the litter box(es) scooped?

Lifestyle / Personality

To which area of the home did the cat have access? Indoors Outdoors Both

Does this cat use a scratching post, or other items?

If this cat lived with other cats, please describe their interaction

If this cat has lived with dogs, please describe their interaction

If this cat has lived with children, please describe their interaction

What ages were the children?

Personality & What Makes This Cat Special

How would you describe your cat's personality most of the time?

Please tell us some things you truly love about this cat!

Are there any quirks or habits you are not fond of in your cat? This helps shelter staff understand your pet and support a successful adoption

Is there anything else that you would like us to know about your cat?

Release of Medical Information and Veterinary Records

Veterinarian's name *

I authorize the veterinarian named above to release this animal's veterinary records to NHS (this authorization is limited to NHS) *

Your full name (typed as your signature) *

Sorry, we could not send your form. Please try again, or call us at 905-885-4131.

Thank you

We've received your surrender form. A member of the NHS team will review it and be in touch. If your situation is urgent, please call us at 905-885-4131.

JavaScript is off, so sending this form lands on a plain confirmation page. You're welcome to send it anyway, or call 905-885-4131 or email info@northumberlandhs.com instead.