Litter Surrender Pre-screening Questionnaire

Litter 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. This form is for litters (2+ animals under the age of 6 months old). If you are in need of surrendering services for animals 7 months or older, please return to our Pet Relinquishment page and complete one surrender application per animal.

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:

She/Her/HersHe/Him/HisThey/Them/TheirsOther
Address:*

Street Address

Street Address Line 2

CityState / 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:*

PhoneEmail
Preferred time of contact:*

MorningAfternoon
Preferred language:*

EnglishSpanishOther
Have you used KC Pet Project services before?*

YesNo

Litter Information
What species is this litter?*

DogsCatsOther
How many animals are in this litter?:*
Approximate age of litter:*
In days, weeks, months, or years. Example: 2 months
Breed:*
Weight:*
How many males are in this litter?:
How many females are in this litter?:
Is this litter spayed / neutered?:

YesNoUnknown
How long have you had this litter?*
Optional: Please add a photo of this litter:

JPG, PNG, GIF or PDF only. 5MB or less.
Cancelof

Agreement
I am the owner or authorized agent/designee for the owner of the animals 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 animals 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 pets and schedule an intake appointment, if necessary.*

I agree
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: