Animal Shelter Intake Form Template
Arrival / Admission Date
-
Month
-
Day
Year
Date
Type of Intake
Rescue
Stray/Found
Drop-off
Surrender
Admission Attendant / Receiver
First Name
Last Name
Owner's Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Animal Information
Animal's Name
Breed / Type
Gender
Color
Age
Weight (lbs)
Animal Photo
Browse Files
Cancel
of
Animal ID
Spayed / Neutered?
Yes
No
Health Status & Veterinary History
Do you routinely bring the animal to a veterinary clinic for check up?
Yes
No
Do you have medical records for this animal?
Yes
No
Does the animal have any medical concerns?
Does the pet have any allergies?
What is the normal diet of this animal?
Vaccination Record
Describe the emotional or mental status of the animal.
Why are you giving up the animal to the shelter? (for surrenders)
Sign up for donation
We are a non-profit organization. We appreciate if you sign-up for a monthly donation.
Choose a donation plan below
prev
next
( X )
Sign up for monthly donation
(
$
9.99
for the
first month
then,
$
4.99
for each
month
)
Sign up for yearly donation
(
$
99.99
for each
year
)
Submit
Should be Empty: