Small Animal Surrender Pre-screening Questionnaire

Small Animal 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?
- Animal Name:
- Species:
  
  Other
- Please describe your amphibian:
- Please describe your reptile:
- Age and/or Birthday:
- Weight:
- Sex:
- Color(s):
- Distinguishing Markings:
- How long have you had your pet?
- 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 pet?
  
  Other
- Have you taken any steps to resolve or remedy the reasons that are causing you to re-home your pet?
- If yes, please describe:
- Are you willing to temporarily foster your pet 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 pet?
  
  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?d 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 pet been vaccinated in the last 12 months?
- Primary Veterinarian (name, clinic, and contact information):
- Is your pet on any medications or special diet?
- If yes, please describe:
- Does your pet have any allergies or medical conditions?
- If yes, please describe:
- Where did you get your pet from?
  
  Other
- Animal shelter or rescue name:
- Where has your pet been living primarily?
  
  Other
- Are you willing to provide a cage, food and bedding at time of surrender?
- If yes, please describe the cage dimensions and the types of supplies you will be providing at time of surrender:
- What brand of food are you currently feeding your pet?
- Is your pet offered fruits and vegetables?
- If yes, how often and what types of fruits and/or veggies?
- Is your pet litter box trained?
- Does your pet like to be petted?
- How often do you trim your pet’s nails?
- What is the size of your pet’s cage or enclosure?
- How often is your pet provided out of cage time?
- Has your pet lived with other animals?
- Please list the other animal(s) your pet has lived with, and describe their interaction(s):
- What types of people has your pet lived with?
  
  Other
- How would you best describe your pet’s personality most of the time?
- Please tell us your pet's "bad habits". If there aren't any, enter "none".
- Please tell us something interesting, unique or fun about your pet, his/her traits, or personality that we can tell potential adopters:
- 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: