2. St. Joseph Animal Control and Rescue Cat Intake Form

4. If you have found a stray cat, do not complete this form. You may call the shelter at 271-4877 and make an appointment to drop it off.

6. Owner Information

8. Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Alternate Phone Number
18. Email Address*
20. If assistance is available to help keep your cat, would you be willing to discuss this with an Animal Resource Representative?

    1. Yes
    2. No

22. Animal Information

24. Animal Name*
25. Breed*
27. Color*
28. Sex*
29. Age*
31. What are you surrendering this cat? (check all that apply)*

    1. Moving
    2. Landlord does not allow pets
    3. Can no longer afford
    4. Owner's health
    5. Pet's health
    6. Other
32. If other, please explain below
34. How long have you owned your cat?
36. Is your cat spayed or neutered?

    1. Yes
    2. No
37. What was the name of the clinic that performed the surgery?
39. Is your cat microchipped?

    1. Yes
    2. No
40. Who is the microchip manufacturer?
42. How would you describe your cat? (check all that apply)

    1. Friendly
    2. Outgoing
    3. Curious
    4. Shy
    5. Skittish
    6. Active
    7. Affectionate
    8. Calm
    9. Quite
    10. Vocal/talkative

    1. Aggressive
    2. Demanding
    3. Unpredictable
    4. Uncontrollable
    5. Smart
    6. Playful
    7. Gentle
    8. Hyper
    9. Fearful
44. Has your cat every bitten a person?*

    1. Yes
    2. No
46. If yes, please explain:
48. Where does your cat receive veterinary care?
49. What name are the vet records under?
51. What your cat currently vaccinated for? (check all that apply)

    1. Rabies
    2. Feline Combo
    3. Feline Leukemia
    4. Not current on vaccines
53. Please list any health issues your cat has:
55. Please list any medications or special diet your cat is on:
57. What brand of cat food does your cat eat?
58. What type of food do you feed?

    1. Dry
    2. Canned
    3. Both
60. When do you feed your cat?
62. Does your cat get along with dogs?

    1. Yes
    2. No
63. Does your cat get along with other cats?

    1. Yes
    2. No
65. Does your cat live with other animals?

    1. Yes
    2. No
66. If yes, check all that apply:

    1. Small dogs
    2. Large dogs
    3. Cats
    4. Livestock
    5. Other
68. Describe your home environment. Select one:

    1. Active
    2. Average Activity
    3. Quite
70. Has your cat been around children?

    1. Yes
    2. No
72. If yes, what were their ages?
74. How does the cat react to children?
76. How does your cat react to new people?
78. Where does your cat spend most of its time?

    1. Indoors
    2. Outdoors
    3. Both
80. Is your cat litter box trained?

    1. Yes
    2. No
82. If no, please explain:
84. Is your cat declawed?

    1. Yes
    2. No
86. Where does your cat sleep? (check all that apply)

    1. Inside
    2. Cat bed
    3. Your bed
    4. Garage
    5. Outside
    6. Other
88. Please list any other information you would like to share with us about your cat:
Leave This Blank:


90. 1. Receive an email copy of this form.
91. Email address

    This field is not part of the form submission.

92. Submit

* indicates a required field