Animal Intake Form

Winter's Grace Animal Intake Form

Please fill out this form to provide details about the animal you have rescued, will be rescuing or are relinquishing voluntarily.
Your Full Name*

First NameLast Name
Your Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Your Email Address*
example@example.com
Pet's Name (if known)*
Type of Pet*

DogCatBirdRabbitHorseGoatPigBearded DragonBirdOther
Breed (if known)*
Age of Pet (if known):*
Gender of Pet*

MaleFemaleUnknown
Approximate Weight of Pet*
Is this an animal you rescued or one you will be relinquishing?*

RescuedThis animal is one I will be relinquishing
If relinquishing, please describe your reason(s) for doing so:
* Please note that any animal being relinquished voluntarily and is NOT a rescue will require a $50 relinquishment fee. This fee helps us cover some of the costs associated with caring for your pet while they are with us, such as food, shelter, and vet care. HOWEVER, this fee could possibly be waived if you agree to foster the animal until adopted, provide updated vet records and possibly bring them to local adoption events. If you have a litter of up to (6) puppies or kittens it would be $75. A litter of (7) or more would be $100.
Please tell us any details about the animal that you know, including their story:*
Does the animal have any behavioral issues that you are aware of? Please explain:
ex: Does not get along with other dogs, cats, livestock, children
Are you willing to foster the animal until an adopter is found?*

YesNo
Is the pet injured or ill?*

YesNo
Is the pet spayed/neutered?*

YesNo
Is the animal house trained? (if applicable)*

YesNoN/A
Is the animal crate trained? (if applicable) if so and you're able to provide that crate while in our care that would help significantly*

YesNoN/A
Is the animal microchipped? (if applicable)*

YesNoN/A
Does the Animal Get Along with other animals including domestic and farm? If not, please mark the correct answer below and explain in further detail under the behaviors section.*

YesNo CatsNo DogsNo Farm AnimalsNo Other Animals
Does the Animal Get Along with Children?*

Yes, Toddlers and Young ChildrenYes, No ToddlersNo
Describe the pet's condition*
Will you be bringing the animal with anything such as a crate, food, litter, medicine, etc.? (bringing these items would be significantly helpful)*
Where was the pet found (if it applies)?

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Where is the Animal currently located?*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Upload any photos of the animal*

Cancelof
Please upload any vet records*

Cancelof
Please Check Each Box Below:*

I certify that I am the legal owner of the above listed animal(s), that I was given permission to rehome the animal(s) by their owner or that I found this animal and made every attempt to find the animals owner.By signing this form, I understand that I am permanently and irrevocably transferring ownership of the animal(s) to Winter’s Grace Animal Rescue.I release Winter’s Grace Animal Rescue from any claims or demands related to the animals care, treatment, disposition, or any potential harm caused by the animal after the surrender.I understand that there is a $50 non-refundable relinquishment fee ONLY if the animal belonged to the person relinquishing it. This fee will go towards the care of the animal(s) while in foster care. HOWEVER, this fee can be waived if I am willing to foster the animal until adopted and ensure all vaccinations are up to date, providing a copy of updated vet records to Winter's Grace Animal Rescue. I may also be required to bring the animal to local adoption events.
Signature of Owner/Rescuer:*
Should be Empty:

Winter's Grace Animal Intake Form