Incoming Cat Profile

Incoming Cat Profile - KW
ID#

____________________________________________________________________

(Please leave this field blank. ID# will be added once the form is submitted).
Date*

MonthDayYear
Date
Owner's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Owner's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cat's name*
Cat's gender*
Cat's breed*
Cat's colour*
Cat's age*
Is your cat spayed or neutered?*

YesNoDon't Know
Is your cat microchipped or tattooed?*

MicrochippedTatooedNeither
If you picked "Microchipped" in the previous question, please provide the microchip number, if available.
Why are you surrendering your cat?*
How long has your cat lived with you?*
Do you have current vaccine records for your cat?*

YesNo
When was the last time your cat was seen by a veterinarian?*

Never3 months6 months1+ year(s)
What is the name of your veterinary clinic?*
Does your cat have any known health problems/old injuries?*
Is your cat declawed?*

YesNo
Describe this cat at a vet exam:*

No signs of fear or anxiety, purrs, easy for vet to handleSome signs of fear, hides in carrier, vet can still handleHissing or growling, hides in carrier, difficult for vet to handleI have never taken this cat to a vetOther
How does this cat handle going into a carrier?*

Doesn't put up a fuss at allFusses a bit but not to difficultFusses a lot and may take more than one tryOther
Where did you get your cat?*

The Humane Society of Kitchener Waterloo & Stratford PerthAnother Humane Society/RescueFound/StrayFriend/RelativeBreederPet StoreSomeone RehomingOther
If you got this cat from someone rehoming them, why were they rehoming the cat?
Who trims the cats nails?*

OwnerVetGroomerNobody/Never been doneOther
How does the cat react to nail trims?*

Sits calmly without fussingFusses a bit but still allows itFusses a lot and takes more than one person or more than one tryRequires sedationI've never had their nails trimmed
is there any body part this cat does not like you to touch?*

HeadPawsStomachLegsTailOther
How many adults (18+) live at home?*
How would you describe this cat with the adults in the home?*

Likes to be with people, rubs against legs, sits on lapsSpends a lot of time on their own but will come out and seek attention on their termsSpends a lot of time on their own and doesn't really seek out attentionOther
How many children live in the home?*
How old are the children in the home?
How would you describe this cat with the children in the home?*

Seeks out children for attention, chooses to be around childrenDoesn't seek out children for attention but doesn't hide from themHides when children are aroundI have not seen this cat around childrenOther
How does this cat interact with visitors?*

Seeks out visitors for attentionDoesn't actively seek out visitors for attention but doesn't hide from themHides when visitors are overI have not had visitors since I've owned this catOther
What other animals live in this home? Check all that apply.*

Dog(s)Cat(s)Small animal(s) (e.g. rabbit, rat, lizard, bird)No other animals live in the homeOther
How does this cat interact with dogs?*

Rubs up against dog, doesn't shy awayKeeps distance from dog but won't run away if dog approachesRuns if dog approaches, hides when dog is aroundI have not seen this cat around a dogOther
How does this cat interact with other cats?*

Plays with and rests beside other catsDoesn't interact much; Not social or aggressive with other catsHides from other cats and avoids themSwats or fights with other catsI have not seen this cat around another catOther
Does this cat go outside?*

Yes - Free roamYes - Only in the backyardYes - Leash walksNo
What things does this cat do that you wish they would stop?*
What things have you done to try to get them to stop?*
Cats can show fear by cowering, running away, hiding or hissing. What makes your cat fearful?*
Please describe the brand of food your cat is being fed.*
Describe this cat when it comes to play.*

Plays with toys on their own and when humans are making toys moveOnly plays when humans make toys moveWon't play with toys even if humans make toys moveI don't know because I don't usually initiate play with this catOther
What does this cat like to scratch? Check all that apply.*

Cat Tree/Scratching PostsCouchesTable legs/chairsCarpetsWood furnishingsOther
How many litter boxes are in the home?*
Where are the litter boxes located?*
Does your cat ever eliminate outside the litter box?*

Yes - Just urineYes - Urine & fecesYes - Just fecesNo
If the cat eliminates outside the litter box, where do you find the accidents?
When did eliminating outside the litter box start?*

1-4 weeks ago1-12 months ago1-3 years agoThey have always done itN/A
What do you think could be causing the elimination outside their litter box?*
Where are this cat's favourite resting spots?*
How many times has the cat bitten a person or animal?*
If the cat has bitten, has it ever drawn blood?*

YesNoN/A
If the cat has bitten, has it ever resulted in a trip to the hospital/doctor?*

YesNoN/A
Please describe any bite incidents
Is there anything else we should know?*
Please provide a picture of your pet

Cancelof
Was a photo provided?*

Yes, a photo was providedNo, I could not provide a photo at this time
The Humane Society of Kitchener Waterloo & Stratford Perth's Euthinasia Policy.
The Humane Society of Kitchener Waterloo & Stratford Perth is dedicated to ensuring no healthy adoptable animal is euthanized, thereby increasing the live release rates of pets in its care. It is our mandate to exhaust all efforts before euthanasia is considered. Every animal’s life deserves a conversation.

Euthanasia may be considered as a last resort for unhealthy and untreatable animals.
If this animal should not be considered an adoption candidate for behaviour or medical reasons, would you like to be informed prior to euthanasia?*

YesNo
blanks* Please initial to verify that you understand the question above. Should you select "No" to being notified about euthanasia, in the previous question, you WILL NOT be contacted in the event that euthanasia has been decided.
By signing below, you the owner, understand that you are relinquishing ownership of the dog; all decisions pertaining to the dog will now be made by The Humane Society of Kitchener Waterloo & Stratford Perth; the possibility that a decision may be made to euthanize and if that decision is made, you have the option to be notified. You also understand that if you selected “NO” to being notified about euthanasia, you will not be contacted, in the event that euthanasia has been decided.
Owner's Signature*

Clear
Date*

MonthDayYear
Date

Staff Signature

Date

______________________________

Note: The Humane Society of Kitchener Waterloo & Stratford Perth at no time will sell, lend or give your personal information to any group or person. This includes List Brokers, Mail Order Businesses, Telemarketers or other companies who would sell their services or products. All information is stored in a secure manner in accordance with the Personal Information Protection and Electronic Documents Act.
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Incoming Cat Profile - KW