First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Cat's Name (use a separate form for each cat)

General Breed:*
Choose one: Abyssinian American Curl American Shorthair American Wirehair Angora Applehead Siamese Balinese Bengal Birman Bobtail Bombay Brazilian Shorthair British Shorthair Burmese Burmilla Calico Canadian Hairless Chanilly/Tiffany Chartreux Chausie Chinchilla Colorpoint Shorthair Cornish Rex Cymric Devon Rex Dilute Calico Dilute Tortoiseshell Domestic Long Hair Domestic Medium Hair Domestic Short Hair Egyptioan Mau European Burmese European Shorthair Exotic Shorthair Extra-Toes Cat (Hemingway Polydactyl) German Rex Havana Himalayan Japanese Bobtail Javanese Korat LaPerm Maine Coon Malayan Manx Munchkin Nebelung Norwegian Forest Cat Ocicat Oriental Long Hair Oriental Short Hair Oriental Tabby Persian Pixie-Bob Ragamuffin Ragdoll Rex Russian Blue Savannah Scottish Fold Scottish Straight Selkirk Rex Siamese Siberian Singapura Snowshoe Somali Sphynx (Hairless) Tabby Tonkinese Torbie Tortoiseshell Turkish Angora Turkish Van Tuxedo

Sex:

Has cat been spayed or neutered?

Color(s):*
Choose one: Black Black (Mostly) Black and White Blue Blue (Mostly) Brown Brown (Mostly) Brown Tabby Calico or Dilute Calico Chocolate Chocolate (Mostly) Cream Cream (Mostly) Fawn Fawn (Mostly) Gray Gray (Mostly) Gray and White Gray, Blue, or Silver Tabby Ivory Ivory (Mostly) Orange Orange (Mostly) Orange and White Red Red (Mostly) Red Tabby Tan Tan (Mostly) Tortoiseshell White White (Mostly)

Coat Length:*
Choose one: Short Medium Long

General Age:*
Choose one: Baby 0-6 Months Young 6-24 Months Adult 2-7 Years Senior 7+ Years Unknown

How long have you owned the cat? If not yours, where did it come from?*

Has the cat been to a vet in the last 12 months?*

Has the cat been vaccinated or has testing been done?*

Does the cat use the litter box?*

Is the cat a picky eater?*

Is the cat good with:

Does the cat have a favorite toy? (Please explain)

Please provide all known background about cat:*

Is there anything we should know about the cat or its personality?*

Reason for surrender:*
Choose one: Owner surrender (must be up-to-date medically, provide vet records) Owner deceased Found as friendly stray Trapped as feral Unwanted kitten litter

Please provide more detail for the surrender reason:*

I certify that the above information is true and that false information will result in the nullification of this intake.

RELEASE AGREEMENT

As the owner/person releasing the cat, I agree to the following:

1. I am asking the Ark to take the cat from me.

2. I understand by doing so, this is an irrevocable transfer of ownership from myself to the Ark of Redemption.

3. If the animal tests positive for any of the diseases, it is understood that we will call you and you must take the cat back.

I have read all the above and in lieu of signature, I agree to abide by all of its provisions.