Service request form
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 or upcoming 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 details of species, breed, age, weight, sex, spayed/neutered, updated vaccines, and their name. 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 dogs temperament, tolerances, behaviors. and special needs. Please include if they are good with other animals. If so, what animals have they been around in the past? Are they good with children? If so, please list ages of children they have been around and explain what they are like with them (ie: Excited, calm, licks them, jumps on them, plays, protects, sleeps with, ignores, etc.). Please let us know if they have a high prey drive or are reactive, leash aggressive, food aggressive, etc. How do they do in the car? Do they tend to trust men or women more? Anything you can think of, we want to know. Thank you!
Please be aware that in order to help you with your pet needs we must be in contact with your case worker. Please provide your case worker's name and number so that we may contact them on your behalf. You may also use this space for any additional information you would like to give us. If you are a case worker filling out this form for your client, please specify this. Thank you.
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