Record for Adopting Family

Registered Name (if available):


AKC Number (if available): Call Name: Tattoo Number:
Sex: Age: Eye Color: Coat Color and Markings:
Date Spayed or Neutered: Dates of Vaccinations: 
Dewormed Date and Drug Used: Method and Date of Heartworm Preventative:
Reason for Surrender to Rescue:
Identified Problems: Obedience Trained? Housebroken?
Good with Children? Other Animals? Name of Attending Vet:
Special Medical Problems: Special Remarks: