Animal Intake Application Form

Name *

First

Last

Street Address

City, State, ZIP

Phone (Home)

Phone (Cell)

Okay to text?

Email *

Reason For Contacting Us *

Please explain the circumstances in which the animal is currently in and why you are contacting us to help.

Veterinarian's name

First

Last

If this is an owner give-up, please list the name of the animal's current veterinarian.

Veterinarian's Phone Number

If this is an owner give-up, please list the phone number(s) of the animal's current veterinarian.

Physical Description of Animal(s) *

Please describe everything you know about the animal you wish us to help with. Include species, breed, age, health, sex, and anything else you think we should know.

Animal's Disposition *

Please share any social or personality traits you know about the animal.

Is the animal in danger or a danger to others? If yes, please describe: *

Describe the animal's current living situation: *

If you are relinquishing an animal, please describe the living arrangements it has been accustomed to. Include its current feed, sleeping and shelter conditions.

Are you willing and able to transport the animal to our rescue? *

Are you willing and able to make a donation or sponsor the animal once it is at our rescue? *

If yes, how much and how often (weekly, monthly, quarterly, yearly)?

How did you hear about us? *

If we do not have a place for the animal(s) you are contacting us about, do you give us permission to share the information on this form with our network of other shelters and resources to try to find a better situation for the animal(s)?

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