Dyan's For Cats' Sake Sanctuary

Cat Sanctuary & Rescue

Cat Surrender / Intake Form

Please complete as much information as possible. Accurate information helps us provide safe, appropriate care.

1. Surrendering person / contact information

We'll send your confirmation here.
Preferred contact method*

2. Cat general information

e.g. "about 3 years"
Sex
Spayed / neutered
Indoor / outdoor
Is the cat currently with you?*

3. Reason(s) for surrender

Please check all that apply*

4. Medical history & current health

Current overall condition*
Name, dose, frequency, last dose.
Is the cat currently showing any of the following?

5. Vaccinations, deworming & flea/tick treatment

Proof of current vaccinations is required when available. Please attach veterinary records, a vaccine certificate, or other documentation in the Attachments section below.

Vaccination records attached
Deworming The cat must be dewormed before intake unless the sanctuary approves an exception due to medical circumstances.
Deworming status
Flea / tick The cat must be treated with an appropriate flea treatment before intake unless the sanctuary approves an exception.
Flea / tick treatment status

6. Veterinarian information

May we contact your vet for records?*
Records provided

7. Behavior, temperament & community living

How would you describe the cat's temperament?
Has the cat lived with cats before?
Community environment The cat will be entering a community environment where other cats may be present. The sanctuary will make reasonable efforts to introduce, monitor, separate, or otherwise manage cats as needed; however, individual compatibility cannot be guaranteed.

8. Adoption / placement authorization

Please select one*
The sanctuary determines whether and when a cat is eligible for adoption based on its welfare, behavior, medical status, and available placement options.

9. Surrender & ownership

Known ownership or custody issues

10. Surrender donation / support

If you are unable to make a one-time donation, please discuss this with the sanctuary. A donation is not intended to determine the value of the cat or guarantee acceptance. Monthly donations help offset food, litter, veterinary care, medications, spay/neuter, parasite prevention, emergency care, and other sanctuary expenses.

Would you consider a recurring monthly donation to help support this cat and other rescued animals?

11. Important disclosures

Please read and confirm each of the following.

12. Emergency / medical authorization

13. Attachments

Optional, but helpful: photos of the cat, vaccination records, microchip documentation, or vet records.

14. Signature & agreement

By signing below, I confirm that I have read and understand this surrender form, that the information provided is accurate to the best of my knowledge, and that I understand the cat will be entering a community sanctuary environment. I understand that the sanctuary may make decisions regarding veterinary care, quarantine, housing, socialization, adoption eligibility, and placement based on the cat’s best interests and sanctuary policies.

Fields marked * are required.