Personality Profile

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Raise the Woof!

Personality Profile and Admission Form

To Surrender Your Pet

In an effort to help us place your pet in an environment best suited to its needs, we ask that you fill out this form as completely and honestly as possible. This information will be provided to the new owner.

Admission

Please read the following three (3) statements carefully and check the lines for all that apply. I assume full responsibility for surrendering this animal to the HSWC Shelter because:(Required)

I guarantee that the surrendered animal is mine.

I have provided a copy of written permission from the owner to the WCHS authorizing the surrender of this animal.

This animal is a stray and I do not know who the owner is.

How long has this animal been in your custody?(Required)

Consent(Required)

While in my custody, I certify that this animal has not bitten anyone or exhibited any sign of illness.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Signature(Required)

Date

MM slash DD slash YYYY

Admission fee paid

HSWC ID#

Medical Records Received

Rables Certificate

S/N Certificate

Vaccination Certificate

Admission Processed By

Date

MM slash DD slash YYYY

Cat Personality Profile

Cat's Name

Age

Color

Breed

Sex

Female

Male

Admitted Altered (spayed or neutered)

Altered by HSWC

Reason for Surrender

Medical Care

Check vaccinations the cat has received

Rabies

Distemper

Feline Leukemia

Date

MM slash DD slash YYYY

Veterinarian

Phone

Has the cat been treated for ear mites?

Yes

Unknown

Date

MM slash DD slash YYYY

Has the cat had kittens?

Yes

Unknown

Last heat cycle, if known

Was the cat supervised during the last heat cycle?

Yes

Has the cat been declawed?

Yes

If yes

Front

Rear

List any known medical problems the cat has:

Temperament

The cat gets along with

Men

Women

Children

Strangers

Was the cat raised with children?

Yes

Unknown

Does the cat get along with other cats?

Yes

Unknown

Does the cat get along with dogs?

Yes

Unknown

Personality

Check all traits that best describe the cat

Traits

Affectionate

Demanding

Finicky

Friendly

Nervous

Playful

Quit

Shy

Vocal

Does the cat like to be picked up?

Yes

Unknown

Is there any part of the body that the cat doesn't like to be touched?

Yes

Unknown

Where doesn't the cat like touched?

Does the cat travel well?

Yes

Unknown

Training

Is the cat litter trained?

Yes

Partially

Does the cat go outside?

Never

Sometimes

Always

Is the cat harness trained?

Yes

Unknown

Is the cat destructive when left alone in the house?

Yes

Unknown

Does the cat scratch the furniture?

Yes

Unknown

Is the cat trained to a scratching post?

Yes

Unknown

Does the cat destroy house plants?

Yes

Unknown

Care

What kind of food is the cat usually fed?

Dry

Soft

Canned

Preferred Brand

How often is the cat fed each day?

Where does the cat sleep?

Does the cat have the complete run of the house?

Yes

Unknown

Does the cat enjoy being groomed?

Yes

Unknown

General Comments

Any information that will help the cat/new owner adjust

Admission

Please read the following three (3) statements carefully and check the lines for all that apply. I assume full responsibility for surrendering this animal to the HSWC Shelter because:(Required)

I guarantee that the surrendered animal is mine.

I have provided a copy of written permission from the owner to the WCHS authorizing the surrender of this animal.

This animal is a stray and I do not know who the owner is.

How long has this animal been in your custody?(Required)

Consent(Required)

While in my custody, I certify that this animal has not bitten anyone or exhibited any sign of illness.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Signature(Required)

Date

MM slash DD slash YYYY

Admission Fee Paid

HSWC ID#

Medical Records Received

Rables Certificate

S/N Certificate

Vaccination Certificate

Admission Processed By

Date

MM slash DD slash YYYY

Dog Personality Profile

Dog's Name

Age

Color

Breed

Sex

Female

Male

Admitted Altered (spayed or neutered)

Altered by HSWC

Reason for Surrender

How long have you had the dog?

Medical Care

Check vaccinations the dog has received

Rabies

Distemper/Parvovirus

Date

MM slash DD slash YYYY

Veterinarian

Phone

Date

MM slash DD slash YYYY

Has the dog had puppies?

Yes

Unknown

Last heat cycle, if known

Was the dog supervised during the last heat cycle?

Yes

List any known medical problems the dog has:

Temperament

The dog gets along with

Men

Women

Children

Strangers

Was the dog raised with children?

Yes

Unknown

Does the dog get along with other dogs?

Yes

Unknown

Does the dog get along with cats?

Yes

Unknown

Is there any part of the body that the dog doesn't like to be touched?

Yes

Unknown

If yes, where doesn't the dog like to be touched?

Does the dog travel well?

Yes

Unknown

Training

Is the dog housebroken?

Yes

Partially

Where is the dog kept during the day?

Inside

Outside

Both inside and outside

Is the dog accustomed to being left alone?

Yes (less than 8 hours)

Yes (more than 8 hours)

Where does the dog sleep?

Does the dog have the complete run of the house?

Yes

Unknown

Does the dog chew when left alone?

Yes

Unknown

Does the dog bark when left alone?

Yes

Unknown

The dog is trained to

Walk on leash

Sit

Stay

Shake paw

Other

The dog is trained to (other)

Care

What kind of food is the dog usually fed?

Dry

Soft

Canned

Preferred Brand

What kinds of treats does the dog like?

Dry biscuits

Bones

Rawhides

Other

What kinds of treats does the dog like? (Other)

Does the dog have any favourite toys?

Does the dog enjoy being groomed?

Is the dog accustomed to regular exercise?

Yes

Unknown

General Comments

Any information that will help the dog/new owner adjust

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Admission

Cat Personality Profile

Medical Care

Temperament

Personality

Training

Care

General Comments

Admission

Dog Personality Profile

Medical Care

Temperament

Training

Care

General Comments

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