Cat Surrender Questionnaire "*" indicates required fields Step 1 of 6 16% Owner DetailsFull Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mobile Phone*Email* Cat's detailsCat's name* Cat's Age* Cat's DOB DD slash MM slash YYYY Breed Sex* Female Male Desexed* Yes No Unsure Microchipped* Yes No Unsure Microchip Number If microchipped, is the cat registered to the current owner?* Yes No Unsure Is the cat registered with your local council?* Yes No Unsure Last vaccination dateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What was the vaccination for? Where did you get your cat?* Did you pay for your cat?* Yes No Unsure Is your cat registered with council?* Yes No Unsure How old was the cat when you acquired him/her?* Please explain why you are surrendering your cat* Lifestyle and home lifeIs your cat allowed inside?* Yes No Sometimes Is your cat allowed outside?* Yes No Unsure Where does your cat prefer to spend most of its time?* Indoors Outdoors When no one is home where is your cat kept?* Where does your cat sleep at night?* How much time does your cat spend on his/her own?* Does the cat like to keep you company when you are home?* Yes No Sometimes Does your cat use a litter tray?* Yes No Sometimes If no, where does your cat toilet?* Outside Other Please explain where your cat goes potty.*Does your cat spray?* Yes No If yes, where and when?*Do you have any other cats?* Yes No Do you have any dogs?* Yes No Do you have any other pets?* Yes No What sort of pet?* How does your cat interact with these other pets?* Behaviour and temperamentDoes your cat have any problem behaviours? (i.e. scratching)* Yes No If yes, please explain what behavioural issues*How many adults and children live at home with the cat?*If there are any children, please specify ages. Is your cat social with adults?* Yes No If no, what do they do?*Is your cat social with children?* Yes No If no, what do they do?*Is your cat social with strangers?* Yes No If no, what do they do?*How active is your cat?* Very Moderately Not very Unsure How playful is your cat?* Very Moderately Not very Unsure How affectionate is your cat?* Very Moderately Not very Unsure Does your cat enjoy being picked up handled?* A lot Sometimes No Unsure Has your cat ever scratched anyone?* Yes No Please provide more details about scratching*Has your cat ever bitten anyone?* Yes No Please provide more details about the bite*Has your cat ever been in a fight with another cat?* Yes No FoodWhat do you feed your cat?* How many times a day is your cat fed?* Is your cat comfortable with people and animals being around when he/she is fed?* Yes No If no, what does the cat do in this situation?*HealthHas your cat ever had any vaccinations?* Yes No Unsure If yes, when?Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What is the name of your current vet? What are the contact details for the current vet? When and why was the last time you took your cat to the vet?* Does your cat have any medical conditions/history that you are aware of?* Yes No If yes, please explain*Is your cat currently on any medication?* Yes No If yes, please explain*Please attach any copy of vaccinations/medical reportsMax. file size: 128 MB. Additional InformationPlease tell us anything else about this cat that you think future adopters would like to knowSurrender Fees*Please note that NRAS requests a surrender fee per animal. If your animal is older than 6mths and not registered, the surrender fee will also include the registration fee needed. Any additional health checks required will also be added to the surrender fee. I understand.*Correct info*If it is found that any of the above information you have supplied is incorrect NRAS reserve the right to pursue any monetary cost from you that arise from any incident/s I declare that all the information I provided is correct.*Signature*HiddenDate DD slash MM slash YYYY