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
*
Please Select
Surrendered to you
Family/Friend Rehome
Personal Rehome
Abandoned/Found
Death of owner
Rescue Org Reach out
Phone Number
*
Your Date of Birth
*
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Please select a year
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Address of Pet
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail Address
*
example@example.com
Have you previously adopted/fostered or surrendered a dog to us before
*
Adopted
Fostered
Surrendered
None
Dog is behaved around: check all that apply
Kids
Cats
Other dogs
Strangers
Do not know
What does your dog do when you are away:
Crate
Outside
Inside free roam
Abandoned/Stray Do not know
Has the dog ever bit anyone or another dog or domestic animal?
Yes has bitten
No has not has bitten
Leash behavior
Pulls
Aggressive
Does not go to the bathroom on the leash
Child can walk the dog/controlled
Barks
Do not know
Please list any information you have about the canine. Ex: Behavior, overall health, fleas, ticks, etc.
How does your dog respond to strangers:
Excited
Scared
Aggressive
Calm
Abandoned/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
*
Browse Files
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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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