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2. Date*
   Date

   Date
3. Animal Name*
4. Animal Breed(s) *
5. Animal Age*
7. First Name*
8. Last Name*
10. Email*
11. Phone Number*
12. Secondary Number
14. Address*
16. City*
17. State*
18. Zip Code*
20. How long have you had this cat?*
22. How does the cat act towards men?*
24. How does the cat act towards women?*
26. Did the cat live with children?*

    1. Yes
    2. No
27. If so, how does the cat act towards children?
28. Ages of children:
30. How was the cat kept during the daytime?*

    1. Indoors
    2. Outdoors
    3. Both Indoors and Outdoors
32. How was the cat kept during the night?*

    1. Indoors
    2. Outdoors
    3. Both Indoors and Outdoors
34. Is the cat friendly with other cats?*

    1. Yes
    2. No
    3. Unknown
36. Is the cat friendly with dogs?*

    1. Yes
    2. No
    3. Unknown
38. Does this cat chase or harm any small creatures or pets? Ex: rodents, small fowl*
40. Is the cat litter box trained?*

    1. Yes
    2. No
    3. Partially trained
42. Does the cat play with toys?*

    1. Yes
    2. No
    3. Unknown
44. Does the cat like treats? *

    1. Yes
    2. No
    3. Unknown
46. Does the cat escape? Ex: Dashing out doors*

    1. Yes
    2. No
48. Does this cat exhibit any dominant or fearful behaviors? Ex: marking, hiding, hissing, swatting*
50. Is the cat affectionate or more independent?*
52. What brand of dry food does the cat eat?*
53. Does the cat eat wet food?*

    1. Yes
    2. No
55. Why can you no longer care for this cat? *
57. Additional Comments:
59. Veterinarian:*
61. By signing below, I certify that I realize by surrendering my pet to Oconee County Animal Services it becomes the property of the county.
63. By signing below, I certify that this animal has not bitten or scratched any person within the last 10 days.
65. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
67. First Name*
68. Last Name*
70. Electronic Signature*
Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit Submit and Print

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