Incoming Dog Profile

Incoming Dog Profile

The information you provide is CONFIDENTIAL.
Thank you for filling out an intake form for Fort Wayne Animal Care & Control. Please understand that you MUST also call and leave a voicemail on the intake help line for a representative to call you back and schedule a time to bring your animal to the shelter. Please sign below confirming you understand that you must call the shelter to schedule a time to bring your animal and this form alone does not mean a time has been set for you.
Signature*

Clear
Part 1: Household
Your name:*
Your email address: *
Phone number: *
Dog's name:*
How long have you had your dog?*
Please specify DAYS, MONTHS or YEARS.
Dog's age:*
Please specify MONTHS or YEARS.
Why can't you keep this dog?*
If we could help you resolve this issue, would you be interested in keeping this dog?

YesNo
Where did you get your dog?*
Where did you find this dog?
What shelter did you get this dog?
Where did you get the dog?

	Friendly	Fearful	Tolerates	Barks at Them	Plays Rough
Children
Strangers

Part 1: Household