636 PALMAS ST.
Owner:___________________________________________________________________________
Address:_________________________________________________________________________
________________________________________________________________________________
Phone:_______________________________
Signature:________________________________________________________________________
Co-owner:________________________________________________________________________
Address:_________________________________________________________________________
________________________________________________________________________________
Phone:______________________________
Signature:_______________________________________________________________________
PLEASE COMPLETE THE FOLLOWING:
PLEASE BE HONEST ABOUT THE ANIMALS FAULTS AND TELL US AS MUCH AS POSSIBLE ABOUT THE ANIMAL. THANK YOU.
Species:__________________________Breed:____________________________________________
Sex:____________Age/DOB:________________Spayed/Neutered: Y/N
Color:_________________________Markings:____________________________________________
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Registration:_______________________________________________________________________
Vaccinations:_____________________________________________________________________
Last de-worming, brand of dewormer used:________________________________________________
Any known health problems:__________________________________________________________
Medications:______________________________________________________________________
Temperament:______________________________________________________________________
_________________________________________________________________________________
Behavioral problems:_________________________________________________________________
_________________________________________________________________________________
Feeding schedule and brand of food used:_________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Special treats:______________________________________________________________________
Animals likes and dislikes:_____________________________________________________________
_________________________________________________________________________________
Reason for surrendering (donating) the animal:_____________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
SURRENDER (DONATION) OF ANIMALS IS FINAL AND CANNOT BE REVERSED. PERFECT HARMONY ANIMAL RESCUE AND SANCTUARY WILL EVALUATE
THE ANIMAL AND DECIDE IF THE ANIMAL IS SUITABLE FOR ADOPTION OR WILL REMAIN IN OUR CARE AS A PERMANENT RESIDENT.
THANK YOU FOR CARING!
Animal received by:__________________________________________________________________
Date:_________________________________