Dog Surrender Pre-screening Questionnaire

Dog 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 Name Last Name
Preferred Name:
Pronouns:

She/Her/Hers He/Him/His They/Them/Theirs Other
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone: *
Please enter a valid phone number.
Alternate Phone:
Please enter a valid phone number.
Email:
example@example.com
Preferred method of contact: *

Phone Email
Preferred time of contact: *

Morning Afternoon
Preferred language: *

English Spanish Other
Have you used KC Pet Project services before? *

Yes No

Dog Information
Dog Name: *
Breed: *
Age and/or Birthday: *
Weight: *
Sex: *

Male - neutered Female - spayed Male - intact Female - intact Unknown
Color(s): *
Distinguishing Markings: *
How long have you had your dog? *
Optional: Please add a photo of your pet:

JPG, PNG, GIF or PDF only. 5MB or less.
Cancel of

Agreement
I am the owner or authorized agent/designee for the owner of the animal described above. *

I agree
The information provided in this questionnaire is accurate and true to the best of my knowledge. *

I agree
I understand that by submitting this questionnaire, it does not guarantee an appointment to surrender my animal(s) to KC Pet Project. *

I agree
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. *

I agree
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty: