Intake Request Form
We try to help in the order of received request, but we never know what larger rescues have the availability to pull. We assure you that your pet would rather be lonely at your home instead of being in an overcrowded rescue. In the past, we have taken on more than we could handle. Overcrowding and stress causes animals to break with viruses and diseases. This not only breaks our hearts to watch them suffer, it causes us to financially go deeper into the hole. We can not continue to help anyone or anything if we are broken. We work with many larger rescues and we can ultimately help the friendly healthy ones get placed. Those with special needs, health concerns, or unsocialized to strangers will take longer. Our goal is to keep pets in their forever homes and out of the shelter. Please be honest when completing the form. Placing your baby into another home under false pretense never turns out well.
Date of Request for help
-
Month
-
Day
Year
Date
Your Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Animal Type
Please Select
Dog
Cat
Other
Pet's breed or best guess.
Pet's Name
Pet's Sex
Pet's Age
How long have you had this pet?
Where has your pet been kept?
Please Select
Inside
Outside
Mixture of both.
Where did you get this pet from?
Has this pet been spayed/neutered?
Please Select
Yes, and I have proof
Yes, but I don't have proof.
No
I am unsure
Reason for request for help...
Please explain any other details such as type of pet if other was selected, vetting completed, vaccinations given and dates, monthly preventatives given and how often, personality traits, likes, dislikes, and any other information that can help us find the right forever home.
Please explain any issues your pet has had with or without you.
Is your pet good with cats?
Please Select
Yes
No
Cat selective
Never been near a cat.
Is your pet good with dogs?
Please Select
Yes
No
Dog selective
Never been near a dog
Is your pet good with kids?
Please Select
Yes all kids
Kids older than 5
Kids older than 12
No kids
Never been near a kid.
Please upload the clear up close pictures of the pet that is needing our help.
Browse Files
Drag and drop files here
Choose a file
Cancel
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Are you able to donate anything to sponsor the vetting needs for this pet?
Please Select
Yes fully
Yes partially
No not at this time
Please sign saying that you are willing to allow our rescue to network this pet and that you will surrender the baby to us if we find an option you are comfortable with.
Submit
Submit
Should be Empty: