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2. To help us place your cat in an environment best suited to his/her needs, please complete this questionnaire as completely and honestly as possible. Thank you!
4. Date
5. Animal #
6. Cat's Name
7. Kennel #
9. Gender

   1. Male

   1. Female

   1. Spayed

   1. Neutered
11. Breed
12. How long have you owned the cat?
13. Where did you get the cat?
15. Is the cat declawed?

    1. Front
    2. All four
    3. No
16. Please list any other surgeries:
17. Please list any medical issues:
19. When is the cat fed?

    1. A.M.
    2. P.M.
    3. Free feed
20. Brand of food:
21. Amount of food:
23. The cat is kept:

    1. Indoors
    2. Outdoors
    3. Both
24. Does the cat mind being picked up?

    1. Yes
    2. No
25. Does the cat mind being held?

    1. Yes
    2. No
27. Has the cat shown any aggression?

    1. Yes
    2. No
28. Explain.
30. Has the cat shown destructive behaviors?

    1. Yes
    2. No
31. Explain.
33. How many litterboxes do you have?
34. Type of Litter
35. Does the cat always use the litterbox?

    1. Yes
    2. No
37. If no, when did the problem start?

    1. From beginning
    2. New cat

    1. New dog
    2. New baby

    1. Move
    2. After declaw

    1. New cat litter
    2. Other
39. Other:
41. Reason for surrendering cat (please be honest)
43. Select all that apply to the cat.

    1. One person
    2. Shy
    3. Nervous

    1. Quiet
    2. Finicky
    3. Active

    1. Playful
    2. Outgoing
    3. Calm

    1. Demanding
    2. Cuddly
    3. Loves to sit on lap
45. Uses scratch post

    1. Yes
    2. No
46. Allowed on furniture

    1. Yes
    2. No
47. Jumps on furniture

    1. Yes
    2. No
48. Good in car

    1. Yes
    2. No
50. Good with:

    1. Dogs
    2. Cats
    3. Kids
51. Kids ages:
53. Anything else potential adopters should know about the cat?
55. I hereby acknowledge that the information, which I have given to the County of St. Charles, is accurate and that the animal is released to the County of St. Charles for disposition and that said County is the rightful owner and I will make no claims whatsoever against the County. I understand and agree that the County of St. Charles is under no obligation to adopt this animal and that the County may otherwise dispose of this animal as it deems necessary.
57. First and Last Name
58. Date
    Date
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60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

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