Phone: 801-423-1334 ~ Fax: 206-202-1961 ~ E-mail: lostpawsinc@gmail.com ~ Hours: 9-5pm Mon-Fri (when able)

(Please read the Surrender Process here first)

LOST PAWS, Inc.

Part A: CAT RESUME

THIS FORM MAY TAKE APROX. 15 - 20 MINUTES TO COMPLETE

No one knows and loves your cat the way you do. In order to find the most appropriate home for your cat, please provide as much detail as possible. Remember that behavioral and medical issues do not necessarily create problems, but failing to disclose them certainly does!

General Information:

Cat’s Name:
Cat’s Age (or approximate age):
Cat’s Birthdate (if known):
Cat’s Sex:	Male Female
Is your cat spayed/neutered?	No Yes Unsure
Is your cat declawed?	No Front All

History:

Why are you surrendering your cat?
If surrender reason is behavioral, please explain:
How long have you owned your cat?
Including yours, how many homes has this cat had?

Medical History:

Did the cat see a veterinarian at least once per year? No Yes Unsure
If so, which clinic?
Is your cat current on vaccinations? No Yes Unsure

Personality:

How would you describe your cat most of the time? (check all that apply)

Friendly to family	Very active	Clown	Couch potato
Friendly to visitors	Playful	Aloof	Withdrawn
Shy to family	Affectionate	Independent	Shy to visitors
Quiet	Lap cat	Fearful	Fearless
Solitary	Talkative	Playful	More like a dog

Habits:

Does your cat:

Claw furniture	Urinate/spray on items	Kill rodents or birds	Chew plants
Dig in plants	Get on furniture	Get on counters	Get on the bed
Go outdoors	Use scratching post	Claw drapes

Has your cat bitten in the last ten (10) days? No Yes
If Yes, explain:

Play Style

How does your cat like to play? (check all that apply)

Plays gently, does not usually use teeth or claws	Likes to play rough, may bite or scratch
Not interested in play	Likes to chase & pounce with variety of toys
Will fetch items like bottle caps or toys	Likes to learn tricks for treats
Likes to play in or around water	Likes to play with other cats
Likes to play with dogs	Likes to play hide & seek
Likes things that crackle, such as paper bags	Chases bugs or moths

Lifestyle & Home Life

What areas of your home did your cat have access to? (check all that apply)

Indoors only	Outdoors only	Indoors at night	Garage/basement
In barn or shed	Screened porch	Indoors with access to outside	Other

Where did your cat spend most of his or her time? (check all that apply)

Bedroom	Kitchen	Living room	Garage or basement
Outdoors only	Barn or shed	Where people are	At the window
Whole house	Other

If this cat has lived with other cats, how did they interact? (check all that apply)

Adored each other	Played together	Sniffed noses	Ignored each other
Rough with others	Groomed each other	Slept near each other	Fought with injuries
Gentle with others	Fought without injuries	Peacefully coexisted

If this cat has lived with dogs, how did they interact? (check all that apply)

Adored each other	Played together	Sniffed noses	Ignored each other
Avoided each other	Groomed each other	Slept near each other	Fought with injuries
Cat feared dog	Caused this cat stress	Dog chased cat	Cat rubbed on dog
Cat tormented dog	Peacefully coexisted

Would you recommend that your cat be placed in a home with other animals?

Any animals

Dogs

Other cats

No other animals

Has the cat regularly been around children? (indicate ages)

No children

0-2 yrs

3-5 yrs

6-10 yrs

11-18 yrs

Have the experiences with the cat and child(ren) always been positive? No Yes
If No, please explain:

Is your cat more comfortable with:
Women Men Kids Teenagers Seniors All people

Dietary Habits

What is the cat's favorite brand of food?
What type of treats does your cat enjoy?
How often is your cat fed?
Food always available Designated mealtimes

How would you describe the ideal home for your cat?

Please tell us some things you truly love about your cat:

Are there any quirks or habits you are not fond of in your cat?

Is you cat litter boxed trained? No Yes
What type(s) of litter was used?

Unscented	Scented	Clumping	Non-Clumping
Crystals	Clay	Pine	Yesterday's News

Any additional comments about your feline friend:

Part B: CAT SURRENDERING FORM

YOU MUST BRING A COMPLETE COPY OF YOUR PET'S MEDICAL RECORDS WITH ANIMAL DROP-OFF

We require a complete copy of current medical records stating that the animal is current on all vaccinations.

Surrendering fees help to offset the costs of veterinary care for rescued animals. The surrendering party agrees to pay to LOST PAWS, Inc. the surrendering fee of $25.00 (Twenty-Five Dollars) for each cat/kitten, or $50.00 (Fifty Dollars) for a litter of kittens.

If you are placing your animal up for adoption because of a behavior or medical problem,
YOU MUST DISCLOSE THIS PROBLEM TO US.

Personal Information

Your Name:
Address:	City:	State:	Zipcode:
E-mail:
Home Phone:
Work Phone:

How did you hear about LOST PAWS, Inc.?

Agreement

I represent and warrant that I am the lawful owner/agent of the Animal(s) and that I have disclosed to LOST PAWS, Inc. all material information regarding the medical and behavioral history of the Animal(s). I understand that by releasing the Animal(s) to LOST PAWS, Inc. I relinquish all ownership or other interest in the Animal(s). I hereby release and forever discharge LOST PAWS, Inc. from any and all rights, claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the Animal(s). And I agree to indemnify and hold harmless LOST PAWS, Inc. from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties. I further acknowledge that I am releasing the Animal(s) completely voluntarily and that no representations or promises of any kind have been made to me by LOST PAWS, Inc. or any of its agents.

I hear by also agree to the undersigned fee for above said cat/kitten is for medical attention and proper care of this animal.

Surrendering Party Initials: *

Payment Information

Surrendering Donation Amount:	$
Would you like to make a donation to the LOST PAWS, Inc. adoption program?	$

Total Donation Amount:	$

Payment Note (if any):

YOU MUST BRING A COMPLETE COPY OF YOUR PET'S MEDICAL RECORDS AS WELL AS YOUR TOTAL DONATION AMOUNT WITH ANIMAL DROP-OFF

-- END OF CAT RÉSUMÉ AND SURRENDER FORM --

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- Adopt a Pet - Surrender a Dog - Surrender a Cat

LOST PAWS, Inc.

Part A: CAT RESUME

Part B: CAT SURRENDERING FORM

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