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:

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?
- What species is this litter?
  
  Other
- 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?:
- 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
- What is the reason for needing to re-home this litter?
  
  Other
- Have you taken any steps to resolve or remedy the reasons that are causing you to re-home this litter?
- If yes, please describe:
- Are you willing to temporarily foster this litter until they 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 this litter?
  
  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.
- Do you own or have you seen the mother of this litter?:
- Do you own or have you seen the father of this litter?:
- If known, when was the mother of the litter last vaccinated?
- Has this litter had any vaccinations?
- Is this litter microchipped?
- Primary Veterinarian (name, clinic, and contact information):
- Is this litter on any medications or special diet?
- If yes, please describe:
- What brand of food have you been feeding this litter?
- Are there any health concerns with this litter?
- If yes, please describe:
- Where did you get this litter from?
  
  Other
- Animal shelter or rescue name:
- Where has this litter been living primarily?
  
  Other
- How long is this litter left alone, without people, on a typical day?
- Does this litter enjoy being handled?
- Is this litter housetrained / litterbox trained?
- Please explain more about this litter's level of housetraining:
- Where does this litter normally sleep at night?
  
  Other
- Please tell us something interesting, unique or fun about this litter, their traits, or personality that we can tell potential adopters:
- What other animals has this litter lived with?
  
  Other
- Have any animals in this litter shown aggression towards other animals?*
- Please describe and explain any circumstances of aggression towards littermates:
- Please describe and explain any circumstances of aggression towards dogs:
- Please describe and explain any circumstances of aggression towards cats:
- Please describe and explain any circumstances of aggression towards livestock:
- Please describe and explain any circumstances of aggression towards small pets:
- Please describe and explain any circumstances of aggression towards wildlife:
- Have any animals in this litter shown aggression towards people?
- Please describe and explain any circumstances of aggression towards people:
- Have any animals in this litter ever inflicted a bite to a person that broke the skin?
- Please describe and explain any circumstances of when any animal in this litter has inflicted a bite to a person that broke the skin:
- What types of people has this litter lived with?
  
  Other
- What ages were the children or teenagers?
- Is there any other information you would like us to know about this litter that may help us find the best placement options for these animals?
- Other information for best placement options:
- I am the owner or authorized agent/designee for the owner of the animals 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 animals 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 pets and schedule an intake appointment, if necessary.
- Signature
- Date
  
  MonthDayYear
  Date
- Should be Empty: