Surrender Questionnaire (Cat) The purpose of the questionnaire is to evaluate the cat's needs and determine the most appropriate foster home for them. No one knows your cat the way you do, so we implore you to take the time to fill out this questionnaire with care, accuracy and as much information as possible to give the cat the best possible chance of success. Your Details Name* First Last Address* Street Address City State Postcode Municipality/Council* Email* Phone Number* Alternate ContactAlternate contact person* First Last Alternate contact phone*Alternate contact Email* Details of animal for surrenderName* Breed* Colour* Date of Birth (or approximate age)* Sex* Male (desexed) Female (desexed) Male (not desexed) Female (not desexed) Current weight (approximately)* Is your pet microchipped?*YesNoNot SureMicrochip Number* Household Information Please list everyone living in the home (including yourself). Example: Mary, 30 years old, Female Name, Sex, Age* Are there any other pets currently living in the house? Yes No Household Pets Please list in other pets (dogs or cats only), not including the one being surrendered. For example: Fluffy, cat, female, 10 years Name, Sex, Age If you have any other pets (for example: rabbits, guinea pigs, livestock, horses) please just list the species and number of animals below. Eg. 2 guinea pigs and 1 rabbit. Reason for surrendering Please be as detailed as possible. Why are you requesting to surrender the cat? Please provide as much detail as possible including any incidents that have resulted in this outcome.* HistoryWhere did you get the cat? (Breeder, pet shop, friend/family, animal shelter, pound, rescue group, Gumtree etc.)* How old was the cat when you acquired him/her?* How long have you had the cat?* What steps have you taken to address the issues relating to the need for surrendering the cat?* HealthPlease provide the name of the vet clinic(s) the cat has been to since you have owned him/her* Has the cat had any illness, disease or injury, past or presentc*YesNoPlease provide as much detail as possible relating to this Has the cat had any procedures or surgeries, past or present? (including desexing)*YesNoPlease provide as much detail as possible relating to this* Has the cat had a vaccination within the last 12 months?* Yes No Not sure Has the cat ever displayed any of the following symptoms?* Select All Sneezing Abnormal discharge from eye(s) Sore eye(s) Abnormal discharge from nose Coughing None of these How old was the cat when desexed? (if applicable) What do you currently feed the cat? Please be specific (type of food, brand, amount)* Living ArrangementsWhere does the cat currently sleep at night?* Where does the cat have access to when no-one is home?* Inside only - free roam Inside only - confined to specific area Inside only - confined to room Inside with outside access Inside with outside access to secure enclosure Outside in secure enclosure Outside only - free roam Where does the cat have access to when someone is home?* Inside only - free roam Inside only - confined to specific area Inside only - confined to room Inside with outside access Inside with outside access to secure enclosure Outside in secure enclosure Outside only - free roam On average, how many hours is the cat left alone per day?* BehaviourPlease tell us about the cat's personality and behaviour traits*What are the cat's likes?*What are the cat's dislikes?*What are the cat's fears/phobias?*What are the cat's bad habits?*Had your cat ever displayed any of the following behaviours?* Urinating outside the litter tray Defecating outside the litter tray Scratching furniture not intended for cat scratching Excessive meowing/yowling Digging up indoor plants Chewing of cables/wires Jumping on countertops Biting humans Has the cat ever interacted with or met another cat?* Yes No Unsure Please detail how they behaved*Has the cat ever interacted with or met a dog?* Yes No Unsure Please detail how they behaved*Has the cat ever interacted with or met a young child?* Yes No Unsure Please detail how they behaved*Has the cat ever interacted with or met a baby?* Yes No Unsure Please detail how they behaved*How does the cat behave in their carrier in a car?*How does the cat behave when being handled at the vet?* Final QuestionsHow long can you hold onto the cat for until we find a suitable foster home?* Less than one week 1 - 2 weeks 2 - 4 weeks 4 - 6 weeks 6 - 8 weeks As long as needed, I just want the perfect home! If you cannot hold onto the cat for at least 6 weeks, are you able to contribute towards the cost of boarding the cat in a cattery at a rate of $30 per day until we can find a suitable foster home?* Yes No If we can accept the cat into our foster program how much are you able to contribute to the foster care and rehoming costs? (Donations are tax deductible)* $50 - The cost for a veterinarian to conduct a pre-adoption health check $100 - Covers a vet check and vaccination $250 - Covers one month in foster care $500 - The average cost for us to rehome one cat Please attach photos of the cat Drop files here or Select files Max. file size: 256 MB. Please attach any veterinary records for the cat Drop files here or Select files Max. file size: 256 MB. I understand that this questionnaire is not a guarantee or promise that Project Underdog Rescue will be able to accept the above mentioned animal into their care.*I understand that this questionnaire is not a guarantee or promise that Project Underdog Rescue will be able to accept the above mentioned animal into their care. I consent to Project Underdog Rescue using the attached images for public advertisement or any other way they deem appropriate.*I consent to Project Underdog Rescue using the attached images for public advertisement or any other way they deem appropriate. I consent to Project Underdog Rescue contacting any veterinary clinics the above mentioned animal has attended to obtain the animal's medical records for the purpose of assessing the animal for placement in their care.*I consent to Project Underdog Rescue contacting any veterinary clinics the above mentioned animal has attended to obtain the animal's medical records for the purpose of assessing the animal for placement in their care. Signature*CommentsThis field is for validation purposes and should be left unchanged.
