Cat Admissions Form

I hereby certify that I own, have assumed responsibility for or have no knowledge of any other owner of this animal prior to this admission. The information I have given Animal Friends, Inc. about this animal’s age, health and disposition is correct. I have truthfully acknowledged any dangerous behavioral characteristics and any past history of biting or aggressive behavior. If, in the sole opinion of Animal Friends, Inc., any of the above statements are incorrect or if the animal reacts negatively to the shelter environment, Animal Friends, Inc. may notify me to reclaim the animal.

I hereby surrender all my interest in this animal to Animal Friends, Inc. I request and understand that the decisions regarding this animal’s care while sheltered and placement into an appropriate home will be as Animal Friends, Inc. deems advisable. I understand that I have no recourse in these decisions, unless recommended or required by Animal Friends, Inc.

I understand that I must give Animal Friends 24 hours notice if I would like to reschedule my appointment to surrender my pet(s). As Animal Friends has many pets in queue to be admitted, I fully understand and agree that my place in line will be lost and my application purged if I fail to keep my appointment to surrender my pet(s). If, after this event, I would still like to surrender my animal(s), I agree to submit new paperwork for review and wait until a space once again becomes available.

Please acknowledge that you have read and agree to the above statement. I agree
Your Name 
Address 
City 
State 
Zip Code 
Phone Number 
Alternate Phone Number 
Email 
Date 
Cat's Name 
Breed 
Color 
Age 
Sex Male    Female   
Is this cat altered? Neutered (male)
 Spayed (female)
 Not Sure
 Pregnant
Is this cat declawed? Yes
 No
 Front paws
 All four paws
At what age? 
Reason for Surrender 
If this is for cat waiting list admissions, how long do you have until you must place the cat? 
When was the cat's last visit to the veterinarian? 
Date of most recent FVRCP vaccination: 
Date of most recent rabies vaccination: 
Date of most recent FELV vaccination: 
Is the cat microchipped? Yes    No   
Has the cat been tested for FELV and FIV? Yes
 No
 Not sure
What were the results? FELV positive
 FELV negative
 FIV positive
 FIV negative
Your Vet's Name 
Phone Number 
How long has this cat lived with you? 
Was this cat adopted from Animal Friends? If so, please call 412.847.8047 Yes    No   
If not, how did you obtain the cat? Another Shelter
 Breeder/Pet Store
 Found/Stray
 Friend/Relative
 Newspaper
If from another shelter, what shelter? 
Have you contacted this shelter? Yes
 No
If the cat was a stray, when/where was it found? 
If you found this cat, did you file a lost and found report? Yes
 No
What is this cat's current living arrangement? Indoor only
 Outside only
 Outside on leash
 Indoor/Outdoor
List the age(s) and gender(s) of people this cat has lived with: 
How is the cat's behavior with children? (check all that apply) Friendly
 Playful
 Tolerant
 Shy
 Afraid
 Aggressive
 Loves Children
 Hides
 Too much for small children
 Never been with children
How does this cat react to visitors? 
How would you describe your household environment? Active
 Noisy
 Quiet
 Average
Which words describe this cat? (check all that apply) Playful
 Affectionate
 Lazy
 Shy
 Rambunctious
 Vocal
 Aggressive
 Aloof
 Lap Cat
List the age/sex/breed/size of any animals the cat has lived with: 
Which of these animals did the cat get along with? 
Does this cat use the litterbox consistently? Yes    No   
If you answered no, has the cat been examined by a veterinarian to rule out physical problems? 
How often does the cat have accidents in the house? All the time
 Once a day
 Once a week
 Never
Is the cat spraying or urinating outside the litterbox? Yes
 No
When did this behavior begin? 
What has been done to correct the problem? 
Where does the cat have accidents? 
What kind of litterbox is the cat used to? Open
 Covered
 Self-Cleaning
What type of litter is the cat used to? Clay
 Clumping
 Pine
 Scoopable
 Recycled newspaper
Does the cat have any physical issues, allergies or medical problems? Please describe: 
Does the cat need any medication or a special diet? Yes    No   
If yes, please describe: 
What type of food does the cat eat? Dry
 Canned
 Other
What brand of food does the cat eat? 
Does the cat eat treats? Yes    No   
Favorite treat: 
When is the cat fed? Morning
 Evening
 Free Fed
Approximately how many hours per day does the cat spend unsupervised? 
Is the cat destructive? Yes
 No
If yes, please describe (scratches furniture/walls, chews wires/chords, etc.): 
What has been done to correct the problem? 
Does the cat use a scratching post? Yes
 No
Is the cat accustomed to: Bathing
 Ear Cleaning
 Being in a Carrier
 Being Picked Up
 Nail Clipping
 Brushing/Combing
 Riding in a Car
Has the cat ever bitten anyone? Yes
 No
If yes, please describe: 
Is there anywhere that the cat does not like to be touched or petted? 
Is this cat frightened of anything? 
Does the cat have favorite toys? 
Does the cat like catnip? Yes
 No
Is the cat a hunter? Yes
 No
Is there anything else the new owners need to know (good or bad) about the cat? 

Cat Admission Form

Animal Friends

Caryl Gates Gluck Resource Center
562 Camp Horne Road | Pittsburgh, PA 15237
Phone: 412.847.7000 | Fax: 412.847.7001
speak@ThinkingOutsideTheCage.org
M-F 11 a.m.-7 p.m. | S/S 10 a.m.-5 p.m.

Copyright 2015 Animal Friends Inc.