Animal Intake
To be filled by owner or finder of the animal
Date of Intake
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Solas Rescue File Number Assigned (to be filled out by Solas Rescue)
Reason for Intake
Stray
Owner Surrender
Transfer from another rescue
Name of Transferring Organization
Best contact if we have any questions on this animal
Name of person filling out this form
First Name
Last Name
Owner or Finder Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
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If Stray, where was the animal found
Was the animal checked for a microchip
Yes
No
If chip was present, Microchip Number
How did your rescue aquire this animal(s)
If this is multiple from the same litter, how many animals?
If this is an owner surrender, please describe why you are surrendering this animal
How long have you had this animal
Date of intake to transferring rescue
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Animal's Name
Species
Cat
Dog
Other
Breed
Color/Markings
Approx Age
Kitten/Puppy
Young (1-3 years)
Adult (4-7 years)
Senior (8+ years)
Unknown
Animal Litter Information
Rows
Name
Color
Gender
Breed
Amimal 1
Animal 2
Animal 3
Animal 4
Animal 5
Animal 6
Animal 7
Animal 8
Animal 9
Animal 10
DOB (if known)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
Unknown
Spayed/Neutered?
Yes
No
Unknown
Microchipped?
Yes
No
Unknown
Microchip Number (if known)
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Is the animal up to date on vaccinations?
Yes
No
Unknown
Approx date of last vet visit
Name of last vet seen
Known Health Issues
Skin condition
Respiratory Condition
Vision or Hearing Loss
Injury
Chronic Illness
Other
Please describe all health issues in as much detail as possible
List any vetting already done and the dates
List of any current medications
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Has the animal shown any signs of aggression
Yes
No
If yes, please describe
Temperment (check all that apply)
Friendly with adults
Friendly with kids
Shy/Timid
Fearful of stangers
Aggressive
Playful
House/Litterbox trained
Good with Cats
Good with Dogs
Does the animal have any of these known behavioral issues
Seperation Anxiety
Excessive barking/meowing
Destructive Behavior
Escaping
Litterbox/ house accident issues
Type option 4
Other
Is there anything else you would like us to know about this animal?
Please upload any vet records or other documents that would be useful to us.
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By signing below, I confirm that this information I have provided is accurate and complete to the best of my knowledge. I understand once the animal is surrendered, the organization has the right to make decisions regarding the animals care, adoption and placement.
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