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Cat Resource Center Inc.
Surrender Form
Wildwood Fl 34785 • (352) 748-5260

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.
We require every surrendered cat to be microchipped. A $10 fee will be added to the deposit if the cat needs to be microchipped on arrival.
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.

I am _____ an individual ___representing a rescue group Rescue group:___________________________

For individuals the total charge to surrender a cat is $5000. As a courtesy and only if you live in California, we will accept monthly payments toward this total, provided that you have first paid a non-refundable deposit of $500 (for cats under 8 years old) and $1000 for senior cats (8 years and older). The minimum monthly payment for non-senior cats is $60 per month until the entire balance is paid (up to 83 months) and $75 per month for senior cats (up to 67 months). If the cat is unvaccinated or unaltered, there is an $80 fee in addition to the deposit.

Note: The full surrender fee is due and payable to The Cat House on the Kings even if the cat dies before full payment has been made. If the cat is adopted before all payments have been made, The Cat House on the Kings will consider the remaining debt to be paid in full and no further payments will be required.

Payment in full discount: If you pay the entire surrender fee at the time the cat is surrendered, the surrender fee will be discounted 10%. e.g. For a non-senior cat the discounted fee would then be $4500.

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

No
How will you make your payments?

PayPal (Preferred)

Automatic Bank Payment

Monthly Check
First name: ___________

Last name: ________ Email _________

Home phone:_______

Cell phone:
_______
Work phone:______

Address: ____________

City: _________

State: _____

Zip:________

Workplace: ________
Work Address_____________________
Nearest Friend not living with you #1 _______________________
Address

City:____________ State ____ Zip: ______
Phone: _________

Nearest Relative Not living with you #1______________

Address: __________________

City:______ State ____ Zip: ______ Phone:

Nearest Relative Not living with you #2________________

Address: __________________

City:______ State ____ Zip: ______ Phone:

Is this cat: Your cat? Stray? Other? If so explain: _____________________________

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

No
Name of cat:________Date of birth (est.)
____

Date of birth (est.) ______

Microchip ID:

Gender:

Male

Female

Breed:


Color:

Veterinarian (if your pet)____________________________

Spayed/neutered?

Yes

No

Don't know
FeLV/FIV test date:

FeLV:

Positive

Negative
FIV:

Positive

Negative
Has the cat been outside since the FeLV/FIV test?

Yes

No
Has the cat had unsupervised contact with any FeLV+ or FIV+ cat since the FeLV/FIV test?

Yes

No
Current on vaccinations?
4 in 1 (FVRCP & C):

Yes

No

Don't know
(All surrenders should have a 4 in 1 booster within 9 months of surrender if possible.)
Leukemia:

Yes

No

Don't know
Rabies:

Yes

No

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________
$
Total exchange points (or N/A):______

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: