Master Record

Rescue Dog #: Registered Name  (if available): AKC Number (if available): Papers Received?
Breeder's Name 
(If known):		 Address: Home Phone Number: Work Phone Number:
Name of Person(s) 
Surrrendering Dog:		 Address: Home Phone Number: Work Phone Number:
Call Name: Sex: Age: Eye Color, Coat Color 
and Markings:
Tattoo Number: Date Spayed 
or Neutered:		 Dates of Vaccinations:
Dewormed Date and Drug Used: Method and Date of Heartworm Preventative:
Rescued from: Owner? Shelter? Breeder?
Pet shop? Caretaker? Other?
Reason for Surrender to Rescue:
Identified Problems: Obedience Trained?
Good with Children? Other Animals? Housebroken? Name and Phone # 
of Attending Vet:
Special Medical Problems: Special Remarks:
Name of Adopting Family: Address: Home Phone Number: Work Phone Number:

Rescue Information
First Contact: Date:
Medical Evaluation: Date:
Boarding Facility: Date:
Foster Home: Date:
Permanent Home: Date:
Follow-Up: Date:

Expenses

Veterinarian $ 
Boarding  
Heartworm  
Medication  
Food  
Shipping  
Other  
Total $ 
Donation for Expenses: ($               )

 

Special Remarks: