Any necessary information marked as NA will not be taken into account. The Jefferson County Humane Society stipulates that individuals wishing to surrender an animal must reside in Jefferson County, unless prior arrangements have been made via email before
completing the surrender form.
Additionally, all individuals surrendering an animal must be able to provide valid proof of address.
City, County, & Zip Code*
Name of person surrendering this animal? ( Only if different from the owner).
Phone # of surrendering person
Relationship to Owner? (Only Answer if Not the Owner)
Please explain why you have to surrender your pet?*
Age:*
Male or Female?*
What color is this animal?
Is this animal up-to-date on vaccinations? *
Has this animal ever bitten anyone?*
Has this animal shown aggression towards other animals?*
If yes please explain how it shows aggression. (Examples, Fighting, Chasing, Taunting)
Has this animal been around dogs?*
If yes how do they act? (Examples: Fine, Scared, Agressive)
Has this animal been around cats?*
If yes how do they act? (Examples: Fine, Scared, Aggressive)
Has this animal been around kids?*
If yes how do they act? (Examples: Good, Fine, Scared, Mean)
Did this animal live Indoors or Outdoors?*
Has this animal been around farm animals?*
Does this animal have any known fears or bad behaviors?
Does this animal have a health condition that disables them?*
If yes, please explain. (Examples: Blind, Deaf, FIV. etc..)
What other information should we know about your cat?
