Guardian Angel Program
Please provide as much correct information as possible so we can ensure appropriate placement.
Full Name
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First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Current Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ownership Authorization
By clicking this box, you are acknowledging that you are the primary owner or you have power of attorney of this animal and are authorized to complete this application.
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Yes I am the primary owner
I have power of attorney and am completing this form on the owner's behalf
I am a case worker assigned to this file and am completing this form at the request of the owner
No, I do not have the owner's authorization but I am completing the form on the owner's behalf
Please describe your situation, including why you are needing temporary care of your pet.
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General Pet Information
If you have more than one pet, please complete ONE application for per pet.
Species
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Dog
Cat
Small Animal
Reptile
Bird
Animal's Name
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Date of Birth/Approximate Age
*
Breed
*
Gender
*
Male
Female
Unknown
Has this animal been spayed/neutered?
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Yes
No
Unknown
Please upload a photo of your pet
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How long have you owned this pet?
*
Where did your pet originally come from?
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Who is your pet's current veterinarian?
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Have they seen a vet in the last 12 months?
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Yes
No
Unknown
If yes, what was the reason for the vet visit?
Has this animal been vaccinated in the last 12 months?
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Yes
No
Unknown
If yes, please upload vaccine records
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Choose a file
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Please list any medications or supplements your pet is on
Please list all surgeries, alterations, or other procedures this animal has received
Do you have any concerns about your pet's health at this time?
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Yes
No
If yes, please explain
Acknowledgement
I acknowledge that all vet records for my animal will be made available upon my acceptance into the GAP program. I acknowledge that my vet clinic will receive my authorization for access to all past history of treatments, surgeries, and vaccines.
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Yes I agree
Vet Care Acknowledgement
I acknowledge that if my pet is not spayed or neutered, microchipped, or vaccinated at the time of intake into the GAP program, that my pet will be spayed or neutered, microchipped, or vaccinated before being returned to me if they are deemed healthy enough by a veterinarian.
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Yes I understand
No, I don't want my pet spayed or neutered, microchipped, or vaccinated while in care
Let's learn about your pet's likes, dislikes and behaviors.
Please answer questions as truthfully and as completely as possible. The more accurate the information, the easier it will be to place them into foster care.
How would you describe your pet? Please check all that apply
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Friendly
Shy
Aggressive with people
Aggressive with dogs
Aggressive with cats
Independent
Couch Potato
High Energy
Playful
Likes to cuddle
Affectionate
Vocal/Talkative
Avoidant
Destructive in the house
Unknown
Is this pet restricted from anywhere in the home? Please check all that apply
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Indoors
Outdoors
Carpet
Kitchen
Couch
Bed
Other
Unknown
Where does your pet spend most of its time?
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Indoors
Outdoors
Equal time indoors/outdoors
Is your pet crate/kennel trained?
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Yes - calm
Yes - anxious
No
Unknown
How is your pet with cats?
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How is your pet with dogs?
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How is your pet with children?
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What food is your pet currently eating?
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Is your pet
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Fully housetrained
Pee Pad trained
Partially trained
Uses litterboxes
Unknown
Has this animal gone to training classes or worked with a private trainer? If so, where/who?
*
*
I am 13 years of age or older
Application Acknowledgement
Thank you for taking the time to provide information about yourself and your pet. By signing below, you acknowledge that all the information provided is, to the best of your knowledge, accurate and true.
Signature
*
Please verify that you are human
*
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