Intake request for CATS

RSPCA

Questionnaire to relinquish CAT(S) to the RSPCA Worcester and Mid Worcestershire branch

The information you give will be used by our staff only as a source of background information on your cat(s) who you need to rehome.
We do not discriminate when it comes to the animals we accept into our care, so please answer all questions honestly,
as this will give us the best insight into your cat's background and behaviours, and will help us find the most suitable home for them.

All personal information supplied by you on this application form will be processed by the Royal
Society for the Prevention of Cruelty to Animals whose privacy policy is available and published
at www.rspca.org.uk/privacy or on request by calling Supporter Services on 0300 123 0346.
This applies whether the information is supplied directly to national RSPCA (charity number 219099),
as data controller, or is shared with us by an RSPCA Branch (RSPCA Worcester is a separately
registered charity no 205930) as a joint data controller. The term "RSPCA" will refer to both data controllers.

A FEW DETAILS ABOUT YOU
Title *
First name *
Surname *
Address *
Town *
County
Postcode *
Best phone number to contact you on *
Email address *
Are you the legal owner of the cat(s) *
If you are not the legal owner of the cat(s) please state your relationship to the legal owner
Please state the reason you're needing to relinquish? *
Where did you purchase your cat(s)? *
What age was your cat(s) when they came into your care?
A LITTLE ABOUT THEIR HOME LIFE
Has your cat ever lived with children, and if so, what age are/were the children and what is your cats behaviour with them? *
Is your cat(s) used to both men and women? *
Has your cat(s) ever lived with other animals, if so, what species and what was their behaviour towards them?
Is your cat indoors only or let outside
YOUR CAT(S) DETAILS
How many cats do you wish to relinquish into our care? *
If you would like to relinquish more than one cat, please state whether they are bonded and ok to go into one of our pens together, or whether they need to be housed separately
Please attach an image of your cat or cats you would like to relinquish
Optional extra image
Optional extra image
Optional extra image
Name of cat(s) *
Age(s) (please select multiple options if they are different ages) *	0-4weeks 4-8weeks 2-6 months 6-12 months 1-2 years 2-5 years 5-10years 10-15years 15+years Unsure
Gender *
Breed *
Colour *
Is your cat(s) neutered? *
Is your cat(s) up to date with vaccinations? *
Is your cat(s) microchipped? *
A LITTLE BIT ABOUT YOUR CAT(S)
Please describe your cat(s) personality? *
Does your cat(s) currently have any medical problems, or have they had any medical problems in the past? If yes, please explain the issues. *
Has your cat(s) ever been to a vet? If yes, which vets were they seen at? *
Please describe your cat's diet (eg: wet/dry) and whether there are any foods that they don't like or are allergic to *
Is your cat(s) litter trained? *
Does your cat(s) travel well? *
Has your cat(s) ever been destructive in the house? If yes please describe *
Is there anything else you would like us to know?
Signature
Date *
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Intake request for CATS

Questionnaire to relinquish CAT(S) to the RSPCA Worcester and Mid Worcestershire branch

A FEW DETAILS ABOUT YOU

A LITTLE ABOUT THEIR HOME LIFE

YOUR CAT(S) DETAILS

A LITTLE BIT ABOUT YOUR CAT(S)