Animal Intake Form
 Check if new intake:  New Intake   Check if updated intake:  Updated Intake 
 Foster Animal's Name:
 Species:   Dog   Cat   Other 

 If a cat, declawed?   Yes   No 

 Date of Birth of Foster:  (Estimated OK)
 Gender:   Male    Female  
 Physical Appearance: (Include Breed (if known), Colors, Distinctive Markings)
 
 Altered?  
 Clinic Name:    Altered on Date: 
 Foster's Microchip Number: 
 Rabies Vaccination Info:
 Clinic: 
 Date of Vaccination: 
 Rabies Tag Number: 
 Other Vaccinations and Treatments:
 (Include Clinic Name, dates, and pertinent comments)
 

 Please provide a brief bio about your foster animal:
 

 Rescue Information (Important): 
 Name of Shelter:  OR
 Location of Feral Site:  OR
 Name of former owner:  (Name, Address, Telephone) OR
 Other Location Rescued From: 
 Date of Rescue: 
 Foster Contact Information: 
 Name:
 Address:
 
 Phone(s):
 Email: