Kittens Surrender Questionnaire

Owner Details

Full Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone*

Email*

Kittens details

Breed*

Age*

DOB

DD slash MM slash YYYY

Number of Kittens*

Number of Males*

Number of Females*

Desexed*

Yes

Unsure

Microchipped*

Yes

Unsure

Microchip Numbers

If microchipped, are the kittens registered to you as the current owner?*

Yes

Unsure

Are the kittens registered with your local council?*

Yes

Unsure

Last vaccination date

What was the vaccination for?

Have the kittens ever been wormed?*

Yes

Unsure

Date of last worming treatment

Were the kittens born in your care?*

Yes

Unsure

If no, how old were the kittens when you acquired them?*

Did the kittens come from*

Breeder

Family Member

Friend

Rescue Group

Other

Please explain why you are surrendering the kittens*

Do the kittens have any known health issues? (please specify)*

Do the kittens have any behavioural issues? (please specify)*

Please fill out this section if the kittens were born in your care

Do you own the mother cat?*

Yes

Do you own the father cat?*

Yes

How long have you owned the mother?

How old is the mother cat?

Is the mother cat vaccinated?

Yes

Last vaccination date

Type of vaccination

Is the mother cat microchipped?*

Yes

Unsure

Microchip number

How many litters has the mother cat birthed in her life?

How many kittens were born in this litter?*

How many weeks did the kittens feed from their mother?*

Are the kittens weaned?*

Yes

Is the mother cat or father cat now spayed / neutered?*

Yes

Lifestyle and home life

Are your kittens kept inside?*

Yes

Sometimes

Are the kittens allowed outside?*

Yes

Sometimes

How many adults and children live in the home?*

If there are any children, please specify ages.

Do the children have contact with the kittens?*

Yes

Regarding contact with the children do the kittens*

Enjoy the kids

Tolerate the kids

Hide from the kids

Other

Please list the animals in the house*

How do the kittens interact with other animals?*

Are the kittens comfortable around strangers?*

Are your kittens litter trained?*

Yes

Sometimes

Additional Information

Please provide any additional information about the kittens

Please attach any copy of vaccinations/medical reports

Max. file size: 128 MB.

Surrender 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*

Hidden

Date

DD slash MM slash YYYY