Animal Intake Form
Fur and Tails Animal Rescue
Intake Date
*
-
Month
-
Day
Year
Date
Intake from:
*
Highlands
LCDAC
Birth
Stray/Rescue
Other
Type of Animal
*
Canine
Feline
Other
Animal Name:
*
Animal Age:
*
Animal Breed:
*
Animal Color:
*
Please upload an image of the animal:
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Animal Sex
*
Male
Female
Neutered Male
Spayed Female
Unknown
Other
Please tell us about the animal's temperament:
*
What is the animal afraid of?, What's it's favorite thing to do?,
Animal Location
Mockingbird
Farm
Other
Is the animal Microchipped?
*
Yes
No
Unknown
N/A
Microchip Number
Microchip Registration Company
Is the animal up to date on required vaccinations?
*
YES
NO
N/A
Unknown
Is the Animal Healthy?
YES
No
Medical or Health conditions:
*
List any current medications:
*
Include parasite (flea /heart worm preventive)
Completed by:
Carri Wagner
Tim Roddy
Susan Buzzell
Erica Sample
Melynn Schowe
Other
Submit Animal Intake
Should be Empty: