Intake

Canine Intake Form

If you have a dog you would like us to rescue please fill out the form below and we will get back to you within 24 hours. Thank you!
Full Name*
Please Select the Type of intake*
Phone Number*
Format: (000) 000-0000.
Your Date of Birth*

DayMonthYear
Address of Pet*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail Address*
example@example.com
AdoptedFosteredSurrenderedNone
KidsCatsOther dogsStrangersDo not know
CrateOutsideInside free roamAbandoned/Stray Do not know
Yes has bittenNo has not has bitten
PullsAggressiveDoes not go to the bathroom on the leashChild can walk the dog/controlledBarksDo not know
Please list any information you have about the canine. Ex: Behavior, overall health, fleas, ticks, etc.
ExcitedScaredAggressiveCalmAbandoned/Stray dog - do not know
Please select the best time (Day and time slot available) for you to transport this dog to our facility. This time will be confirmed when we contact you about your intake*
Pleas submit: photo of the canine as well as any medical records they have (required for a rehome) and a photo of where the dog was found if the intake was abandoned*

Cancelof
ABANDONED/FOUND ONLY *please describe the area in which the dog was found. Ex: Woods, rural, city, chained up etc.
Terms and conditions: Upon approval- You will be given a date and time of transfer. You will be expected to transport you approved intake to the designated transfer site, and making one stop at our vetted site for your intake to get vaccinated if needed. If you agree to the terms please type I agree and then sign below*
Signature

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Canine Intake Form