Cat Surrender Pre-screening Questionnaire

Cat Surrender Pre-screening Questionnaire
KC Pet Project only accepts animals from Kansas City, Missouri. If you are a Kansas City, Missouri resident in need of assistance, please complete the following form. You should submit one form per pet you are requesting to surrender or relinquish to KC Pet Project.

It is important that the answers provided for surrender questionnaires and assessments are honest and detailed. This information is all KC Pet Project has to help set the pet up for success while in our care and in-depth information allows us to find the best outcome for the pet, including placement options and matchmaking for adoptions.

Once you have submitted your questionnaire, a Pet Support Specialist will contact you to gather any additional information, discuss what options are best for the pet, and/or schedule an intake appointment for the pet to be surrendered to KC Pet Project at the Kansas City Campus for Animal Care. If you have any questions, please call 816-683-1383. Thank you.
Name:

First NameLast Name
Preferred Name:
Pronouns:

Other
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
Preferred method of contact:
Preferred time of contact:
Preferred language:

Other
Have you used KC Pet Project services before?
- Cat Name:
- Breed:
  
  Other
- Age and/or Birthday:
- Weight:
- Sex:
- Color(s):
- Distinguishing Markings:
- How long have you had your cat?
- Optional: Please add a photo of your pet:
  
  JPG, PNG, GIF or PDF only. 5MB or less.
  Cancelof
- What is the reason for needing to re-home your cat?
  
  Other
- Have you taken any steps to resolve or remedy the reasons that are causing you to re-home your cat?
- If yes, please describe:
- Are you willing to temporarily foster your cat until it can be adopted?
- If yes, for how long?
- Are you interested in private re-homing through our Supported Re-homing Services?
- If we could provide you with any of the following resources, would you be able to keep your cat?
  
  Other
- Please describe what type of medical assistance:
- Research has shown a correlation between the mistreatment of animals and the presence of domestic violence within households. Your answers to the following questions help our team partner with you and connect you to services and resources available to you.
- Has your current/former partner harmed or threatened to harm your pet?
- Has your current/former partner harmed or threatened to harm you?
- Do you feel unsafe in your home because of a current/former partner?
- We're here to help. Learn more about our supportive programs.
- Has your cat been vaccinated in the last 12 months?
- Is your cat microchipped?
- Microchip Number:
- Has your cat ever been tested for Feline Leukemia (FeLV)?
- Has your cat ever been tested for Feline Immunodeficiency Virus (FIV)?
- Is your cat declawed?
- If yes, how old was your cat at the time of surgery when was the declaw surgery performed?
- Primary Veterinarian (name, clinic, and contact information):
- Is your cat on any medications or special diet?
- If yes, please describe:
- What do you feed your cat?
- What brand of cat food do you feed your cat?
- How often is your cat fed?
  
  Other
- Does your cat have any allergies or medical conditions?
- If yes, please describe:
- Where did you get your cat from?
  
  Other
- Animal shelter or rescue name:
- Where has your cat been living primarily?
  
  Other
- Has your cat ever been outdoors?
  
  Other
- How long is your cat left alone, without people, on a typical day?
- Is your cat litter box trained?
- Please explain more about your cat's level of housetraining:
- What toys and games does your cat like?
- When your cat plays, does he/she typically:
- Is your cat afraid of anything?
- Please describe:
- Is your cat allowed on the furniture?
- Does your cat scratch furniture or use scratching posts / items?*
- Please describe:
- Please tell us your cat's "bad habits". If there aren't any, enter "none".
- Please tell us something interesting, unique or fun about your cat, his/her traits, or personality that we can tell potential adopters:
- What other animals has your cat lived with?
  
  Other
- Has your cat ever attacked another animal resulting in severe injury or death?
  
  Other
- Please describe the activities that resulted in the injury or death of another animal by your cat:
- Has your cat ever reacted to other animal types by hiding, hissing, swatting or biting?
- Please describe the activities that led up to any snap or bite occurrence with a familiar pet:
- Has your cat bitten anyone in the last ten (10) days?
- If yes, what day and in what city did the bite occur in?
- If yes, please explain any injury that resulted from the bite incident:
- Has your cat ever inflicted a bite to a person that broke the skin?
- Please describe the activities that led up to any bite occurrence that broke the skin:
- What types of people has your cat lived with?
  
  Other
- Has your cat ever reacted to a person by hiding, hissing, swatting, or biting towards any of the following populations:
- Please describe the activities that led up to any swatting or bite occurrences with a person or child:
- Has your cat ever inflicted a serious bite to a person?
- If yes, what day and in what city did the bite occur?
- If yes, please explain any injury that resulted from the bite incident:
- Has your cat ever shown any of the following behaviors when trying to pick them up or hold them, when attempting to pet them, while petting them, or while trying to trim their nails?
- Please describe and explain any circumstances or any swatting or bite occurrence:
- Is there any other information you would like us to know about your pet that may help us find the best placement options for this animal?
- Other information for best placement options:
- I am the owner or authorized agent/designee for the owner of the animal described above.
- The information provided in this questionnaire is accurate and true to the best of my knowledge.
- I understand that by submitting this questionnaire, it does not guarantee an appointment to surrender my animal(s) to KC Pet Project.
- I acknowledge that by completing this questionnaire I am requesting pet surrender support and/or services through KC Pet Project and that I will be contacted at a later date to discuss my pet(s) and schedule an intake appointment, if necessary.
- Signature
- Date
  
  MonthDayYear
  Date
- Should be Empty: