FJAH Animal Intake Questionnaire

Is the pet you are looking to surrender owned by you? *
We can only accept intake requests submitted by the owner of the pet. Please have the owner fill this form out so that we get accurate information. If the owner is not able to fill out the form, please explain why.
First Name *
Last Name *
What is the best phone number to reach you at? *
What is your email address?
What is your address? *
What city do you live in? *
What state do you live in? *
What veterinarian do you currently use? *
*	I understand that I will be required to supply all of my pets medical records from the vet in order to surrender to Father John's.
Do you want to surrender a dog or a cat? *
What is the name of your pet? * If you want to surrender more than one pet, please list the number of pets instead of their names.
How old is your pet? * If you are surrendering multiple pets, please list all of their ages.
Is your pet spayed or neutered? *
What breed is your pet? *
Can you describe their coat color? *
Pet description *
Where did you aquire your pet? *
*	Please understand that most breeders and rescues REQUIRE you to return the pet only to them or notify them prior to surrendering your pet.
What is the name and number or email for the breeder? *
What is the name and number or email for the rescue? *
Please explain how you got your pet. *
How social is your cat? (1=shy & 5=affectionate) *
Is your pet up to date on vaccines? *
*	We HIGHLY recommend that your cat be up to date on their distemper vaccine prior to entering the shelter for their protection.
*	We HIGHLY recommend that your dog be up to date on their distemper and bordetella vaccines prior to entering the shelter for their protection.
Is your cat positive for FIV or Felv? *
Would you be willing to get them tested for FIV/Felv prior to entering the shelter? Testing for FIV/Felv helps us determine if we have an appropriate space for you pet to be housed.
When was you cat tested for FIV/Felv
Has your dog been tested for heartworms? *
When was you dog last tested for heartworms?
Was the heartworm test negative or positive? *
Does your cat go outside? *
How much does your dog weigh?
Did you find your cat? *
How did you catch your cat when you found it? *
How long have you owned your pet? *
Is your pet on any medications and what are they for? *
Does your pet have any medical conditions, symptoms or illness? *
Does your pet have any training or know any commands? *
Has your pet ever agressively bitten or scratched anyone? *
*	Please be advised that if your pet has bitten anyone you are legally required to quarantine them during the ten day period after a bite. We may not be able to take a pet that has severe behavioral issues.
Please explain the situation. *
How is your pet with seniors? *
How is your pet with kids? *
How does your pet get along with cats? *
How does your pet get along with dogs? *
Are there any animals your pet does NOT get along with? *
Which animals does your pet not get along with and how so? *
Please explain why you would like to surrender your pet. *
What date do you need to find placement for your pet by?
Is there anything else you think we should know about your pet?
Please upload upload a picture of your pet If you are trying to surrender a kitten, please take a picture holding them so we can get an idea of their size to better age them.
*	I understand that I will be required to bring 7 days worth of food for my pet if Father John's take them.
*	I understand that I will be required to bring unwashed bedding or blankets that retain my pets smell to help ease their transition into the shelter.
*	I understand that I will be required to pay a $100 surrender fee for a dog, $50 surrender fee for a cat or a $25 surrender fee for a kitten, should Father John's take my pet.
*	I understand that filling out this form does not guarantee my pet will be accepted into the shelter and that Father John's makes the decision to take an animal at its sole discretion.
I certify that all of the above information is complete, true and accurate to the best of my knowledge. *