Animal Shelter Intake Checklist Form
Complete this checklist to record essential animal information at intake.
Date of Intake
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Animal Species
*
Please Select
Dog
Cat
Rabbit
Bird
Other
Breed (if known)
Estimated Age (years)
Sex
*
Male
Female
Unknown
Intake Reason
*
Please Select
Stray
Owner Surrender
Transfer from Another Shelter
Confiscation
Other
Health Status at Intake
*
Appears Healthy
Injured
Sick
Requires Immediate Attention
Microchip Present?
*
Yes
No
Unknown
Vaccination Status
*
Up to Date
Not Up to Date
Unknown
Behavioral Notes or Observations
Submit Intake
Should be Empty: