Surrender Form Computer Generated

Cat Resource Center

Surrender Form Computer Generated

I am

an individual

representing a 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

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 burth (set.)

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?

Yes

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

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:

We require a relatively recent digital picture of the cat to be surrendered. Ideally it should show any distinguising marks or characteristics to help us identify the cat in the future. The picture must be in JPEG (".jpg"), GIF, PNG or BMP format and the picture file must not be larger than 4Mb. Just click the Browse button and select the picture file.
Picture file:
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 agree to these conditions and understand that I must sign a printed copy of this agreement when the cat is surrendered.
I confirm that I have contacted Lynea to obtain approval.
I understand that the surrender fee is not tax-deductible.
I understand that the deposit is non-refundable.