Service Request Form (SRF)
For clients
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address (if you do not have a physical address please specify a neighborhood you tend to stay in or cross streets you are near)
*
Street Address
Street Address Line 2
City
State
Zip Code
I'm interested in:
*
Temporary care for my animal while I am in recovery.
Temporary care for my animal while I am in transitional housing/seeking housing
Temporary care for my animal while I am in the hospital
Temporary care for my animal while I am incarcerated
Temporary care for my animal due to natural disaster/displacement
Temporary care for my animal due to an unsafe home
Non judgmental surrender of my animal
Other: ______________________________
Please tell us how you heard about Array Animal Rescue
Please Select
Referral from case worker
Family/friend
Staff member
Facebook or Instagram
Nextdoor
Other social media
Another organization
Other
Thank you!
Please describe your current situation the best you can with the space provided. Let us know how long (up to 12 weeks) you expect to need a foster for your pet(s). Tell us about your pet(s). Include their name, breed, age, weight, sex, spayed/neutered, and vaccines status. If you have a vet clinic you use, please provide information and list medications they are on, if any.
Please use the space below to write very specific details about your dog's temperament, tolerances, behaviors,or special needs. Please include how they are with other animals and/or children. What is their behavior with children (ie: calm, excited, playful, protective, etc.)? Please let us know if they have a high prey drive or are reactive or aggressive. Be aware that we do not accept any aggressive or highly reactive dogs into our program. Please list anything you think is important for us to know about your pet. Thank you!
Please be aware that in order to help you with your pet's needs we must verify your eligibility with your case manager, P.O. or DV advocate. Please provide their name, number and email address so that we may contact them regarding your case. You may also use this space for any additional information you would like to give us. If you are a case manager, P.O. or DV advocate filling out this form for your client, please specify this. Thank you.
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