Intake Request Form

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Intake Request Form

Please fill out this form in its entirety. It is of utmost importance that we obtain the most information we can about your pet(s) in order to determine placement needs and whether we are able to help you rehome your pet(s).It may take up to a week for us to respond to your request. Please be patient while we work to help the pets of our community.

Email *

Full Name * *

Address * *

City

State/Province

ZIP/Postal Code

Primary Phone *

Secondary Phone *

Are you able to make a donation to cover the animal's expenses?

Yes

Maybe

Clear selection

Please enter amount in USD

Please select the animal type *

Dog

Cat

Please enter how many + additional information:

Animal name(s)

Animal Gender(s)

Breed and Description(s)

House trained? *

Yes

Leash/Crate Trained? *

Yes

Date of Vaccines, if known:

YYYY

Spayed/Neutered *

Yes

Unknown

Approximate Age(s)

Approximate Weight(s)

Is This Animal?

Family Pet

Stray

Relative's Pet

Clear selection

How long have you had the animal?

Has the animal ever bitten or shown aggression toward animals or people?

Can the animal jump a fence?

Yes

Clear selection

If yes, how high?

Why are you relinquishing this animal? *

Are you able to keep the animal in your home for a period of time prior to relocation?

Yes

Maybe

Clear selection

Submit

Clear form

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