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ANIMAL SHELTER - INTAKE FORM


DATE:_____________  BREED:________________________________________________

SHELTER NAME:____________________________________  TOWN:__________________

SHELTER CONTACT:_________________________________  PHONE:_________________	

STRAY: Y/N  OWNER TURN-IN: Y/N  AGE:__  SEX:__  ALTERED: Y/N  COLOR:______


OWNER TURN IN DATE:________ AKC PAPERS: Y/N AKC#____________ HOUSEBROKEN:Y/N BARKER: Y/N GOOD WITH CHILDREN: Y/N AGES:____________ DOG AGGRESSIVE: Y/N DIGS: Y/N GOOD WITH OTHER ANIMALS:____________________ NAME:_______________________ REASON FOR TURN IN:_______________________________________________________ SHOT RECORD:______________________________________________________________ OTHER COMMENTS.
STRAY LOCATION FOUND:___________________________________ I.D.TAGS:_____________ CONDITION OF DOG:_________________________________________________________ OTHER COMMENTS:___________________________________________________________
COSTS SHELTER RELEASE: SHOTS: SPAY/NEUTER: OTHER MEDICAL: OTHER: TOTAL COST: __________________________________________________________________________ DISPOSITION OF DOG: