RVHS/NPAS Shelter Intake Form: Cat
Requirements at Approved Intake:
This form is an application and does not guarantee any placement or intake status at Needy Paws Animal Shelter
Intake Requirements (please select all information you will submit):
Valid Photo ID
Owner Surrender Form (provided upon acceptance)
Medical Records including Rabies Certificate
Completed Profile to assist adopters with selecting a new pet (this application)
Intake Fee as Determined after Intake Exam
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OWNER SURRENDER INFORMATION
Email
*
example@example.com
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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CAT INFORMATION
1. Cat's Name:
*
2. Age or Birthday if known:
*
3. Gender:
*
Female
Male
4. Spayed/Neutered:
*
Yes
No
Unknown
6. Cat breed/colors/markings
*
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This Application is for:
Stray/Abandoned Cat
Owner Surrender (My Personal Pet Cat)
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Cat Ownership History
1. Where did you acquire your cat?
*
2. How long have you had your cat?
*
3. What issues are you having with keeping your cat?
*
Pet's Behavior
Pet's Health
Owner's Health
Finances
Housing
Family
Other
For "Other" please explain below:
*
What have you done to try to keep this cat in your home?
*
What have you done to try to keep this dog in your home?
*
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MEDICAL & DIETARY INFORMATION
1. When was the last time your cat was seen by a veterinarian?
*
2. Name of Veterinary Clinic:
*
3. Clinic Phone Number:
*
Format: (000) 000-0000.
4. Cat's current medications:
*
5. Cat's current weight:
*
5. Describe any past or present health problems or injuries:
*
6. List any allergies your cat may have:
*
7. Food and schedule:
*
Dry
Canned
Table Scraps
Prescription
Other
8. Feeding Schedule:
*
9. Brand(s):
*
10. Favorite treats :
*
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PERSONALITY PROFILE
1. What is your cat's personality like (select all that apply)?
*
Cuddly
Affectionate
Mouthy
Curious
Energetic/Active
Jumpy
Playful
Independent
Goofy
Talkative
Calm/Gentle
Outgoing
Shy
Couch Potato
Fearful
Other
2. What does your cat like to play with (select all that apply)?:
*
Ball
Kong/Treat filled toy
Squeaky/soft toy
Hard toy
Water
Laser pointer
His/her tail
Other cats
Dogs
Puzzle toy
Other
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HOME ENVIRONMENT AND BEHAVIOR
1. Including yourself, indicate the age ranges of people your cat has lived or interacted with:
*
Seniors
Adults
Children under 5 years
Children between 6-12 years
Children between 13-17 years
2. How does your cat react to children:
*
Friendly/Playful
Avoids
Fearful
Unpredictable
Roughhouses
Calm/Easygoing
Snappy
Gentle
Growls/Barks
Never been around
3. Please indicate which types of dogs your cat is compatible with:
*
Male
Female
Small
Medium
Large
Puppy
Adult
Senior
Special Needs (blind, deaf, disabled etc.)
4. Please indicate which types of cats your cat is compatible with:
*
Male
Female
Small
Medium
Large
Kitten
Adult
Senior
Special Needs (blind, deaf, disabled etc.)
5. Please indicate how your cat reacts to other animals, including animal type.
*
Future adopters will need to know if your dog is compatible with livestock and other animals on their property. Please be as specific as possible ("dog has chased chickens on multiple occasions").
6. How does your cat react around food, toys and treats with people?
*
Does nothing
Takes nicely
Takes roughly
Growls/Snappy
Other
7. How does your cat react around strangers?
*
Does nothing
Takes nicely
Takes roughly
Growls/Snappy
Other
8. Describe your cat's behavior when:
Rows
Calm
Excited
Fearful
Other
In the Car
Grooming/Bathing/Nail Trims
Handled by a Vet
If you selected "Other" above, please explain below or type "N/A"
10. Is your cat litter box trained?
*
Yes
No
Partially
Only when crated
Puppy pads
11. Where does your cat live:
*
House
Apartment
Garage
Outside in yard/pen
Inside in crate/round pen
Other
12. Where does your cat sleep:
*
On furniture
Floor
Dog bed
On people
Outside in yard
Crate/gated area
Other
14. Is your cat frightened of anything?
*
Men
Women
Children
Strangers
Vet/Groomers
Fireworks
Thunder
Vacuum
Crate
Bikes/Skateboards
Cars
Loud voices/Yelling
Being left alone
Other
If "Other," please explain:
15. Please describe any body parts your cat does not like being touched and what is the reaction:
16. Is there any other information you would like us to know about your cat?
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Cat Bite Disclosure
Has this cat ever bitten a person or animal?
*
No
Yes (explain in detail below)
Cat Bite History (include dates & circumstances)
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FINAL STEPS!
Please upload images of the animal(s) you are requesting intake for
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I understand that this application is for information purposes only and does not guarantee intake at any time at Needy Paws Animal Shelter
*
Type "I agree"
I understand that any status I receive will be by email from intake@needypawsanimalshelter.org and no phone calls or other messages will be answered by our Intake team
*
Type "I agree"
I understand that I am responsible for an intake fee for this animal/litter and will pay immediately if this intake application is approved.
*
Type "I agree"
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