The Cat House on the Kings Surrender Form

	The Cat House on the Kings Surrender Form 7120 S. Kings River Rd., Parlier, CA 93648 • (559) 638-8696

Please note:

We require evidence from a veterinarian that your cat has been tested for FeLV and FIV so that we can provide proper care. This test must be repeated if your cat has either been outside or exposed to other cats who are FeLV+ or FIV+ since this test was done.
The transition into the sanctuary is especially stressful for older, extremely timid and/or obese cats, to the extent that they may suffer significant health issues. We cannot guarantee their continued well-being. Therefore, the sanctuary should be the very last resort for these particular cats. We will gladly work with you to find an alternative which may be better for the cat.

This cat is being surrenderd by

an individual

a rescue group

For an individual we charge a surrender fee of $45 per cat per month. The maximum total per-cat surrender fee is $3000 (67 months) . There is an additional upfront fee of $80 for an un-neutered, un-vaccinated cat/kitten. Senior cats (8 years or older) are much more likely to incur medical expenses. Consequently the surrender fee for senior cats is $60 per-cat per-month to a maximum per-cat total of $3000 of which $1000 is due when the cat is surrendered. If the cat is adopted or passes away, our agreement is terminated.

The Surrender fee is NOT tax-deductible because we are providing the service of lifetime care for the surrendered cat in exchange for the fee.

Are you willing to pay the surrender fee?

Yes

First name:

Last name:

Email:

Home phone:

Cell phone:

Work phone:

Address:

City:

State:

Zip:

Workplace:

Work Address:

City:

State:

Zip:

Nearest Relative/Friend NOT LIVING WITH YOU #1:

Address:

City:

State

Zip:

Phone:

Nearest Relative/Friend NOT LIVING WITH YOU #2:

Address:

City:

State

Zip:

Phone:

Is this cat

Your pet?

Stray?

Other?

Why can't you keep this cat?

If not your pet, where did this cat come from?

Did you try to find the cat's owner?

Yes

Name of cat:

Date of birth (est.)

Microchip ID:

Gender:

Male

Female

Breed:

Color:

Veterinarian (if your pet):

Spayed/neutered?

Yes

Don't know

FeLV/FIV test date:

FeLV:

Positive

Negative

FIV:

Positive

Negative

Has the cat been outside since the FeLV/FIV test was done?

Yes

Has the cat had unsupervised contact with any FeLV+ or FIV+ cat
since the FeLV/FIV test was done?

Yes

Current on vaccinations?

4 in 1 (FVRCP & C):

Yes

Don't know

(All surrenders should have a 4 in 1 booster within 9 months of surrender if possible.)

Leukemia:

Yes

Don't know

Rabies:

Yes

Don't know

Please tell us as much as you can about this cat:

If you default on this agreement, we reserve the right to return your cat/cats either to your residence or to your relative/friend's residence or to take legal action against you.

I, the undersigned, agree to these conditions.


Signature	Date
IN WITNESS WHEREOF the parties hereto have executed these presents the day and year above written.

Signature	Date

Max. Amt. Owed this Surrender	$
Amt. Paid Today	$	Cash	$	Check #
Remaining Balance Due This Surrender:	$
Amt. To Be Paid per Month:	$
The monthly payment will begin (mo/yr):	/	and on the first of each month thereafter.

(For Office Use Only)
Spay/Neuter:	$	Vac/Shots:	$	Vet/Other:	$	(describe)
Microchip ID:
Intake housing:
Notes: