Mom & Kitten Rescue Intake Form
Use this form to record intake details, mother cat information, kitten litter breakdown, initial medical protocol, and legal release signatures. Include the section headings as listed and preserve the printed/preview layout with spacing and line breaks.
General Intake Information
Intake Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Intake Type
*
Stray/Found
Owner Surrender
Shelter Transfer
Intake Processor Name
*
Litter Assigned Name/ID
*
Finder / Surrender Contact Details
Full Name
*
First Name
Middle Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Exact Location Found
*
Circumstances Found
*
Mother Cat Profile
Assigned ID / Name
*
Estimated Age
Primary Breed / Color
Microchip Found?
Yes
No
Microchip Number
Behavior / Socialization
Friendly/Handleable
Feral/Fearful
Aggressive
Nursing Status
Actively Nursing
Mastitis Present
Dry
Medical Observations
Fleas/Ticks
URI (Sneezing/Eye Discharge)
Wounds
Emaciated
Kitten Litter Breakdown
Total Number of Kittens
*
Estimated Kitten Age
*
Newborn
1-2 weeks
3-4 weeks
5-6 weeks
7+ weeks
Feeding Status
*
Exclusively Nursing
Eating Gruel/Wet Food
Needs Bottle Supplement
Temp ID / Marking Table
*
Initial Medical Protocol Check
Flea/Tick Treatment Administered?
*
Yes
No
Product
Dewormer Administered?
*
Yes
No
Product
Mom FVRCP Vaccine Given?
*
Yes
No
Mom Combo Tested (FIV/FeLV)?
*
Yes
No
Result
Print Section
Legal Release & Signatures
Legal Release Statement
Finder / Surrender Signature
*
Date
*
-
Month
-
Day
Year
Date
Intake Staff Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: