ARG ID #:

 [ ] Neck tag

 [ ] Paint

 [ ] Crayon

 [ ] Other

 Date:

 Microchip#:

 Brand:

 [ ] Pre-existing

 [ ] ARG implant

Description:

 Species:

 Breed:

 Gender:

 Age:

 Approx. wgt.:

 Color:

 Name:

 Tag info:

 Tattoo, marking, scar, collar, etc.

 [ ] Admitted by owner at shelter

 [ ] Admitted by owner at roadblock

 [ ] Admitted by ARG crew

 [ ] Found stray by:

At:

 Owner Information:

 Obtained by:

 ARG volunteer ID#:

 Date:

 Name:

 Contact phone#:

 Email:

 Mailing address:

 Proof of ownership:

 [ ] microchip verification

 [ ] animal registration + owner photo ID

 [ ] other:

 Animal's Medical Information:

 Vaccinations:

 Daily medications:

 HWT/HWP:

 FeLV, FIV test:

 Coggins:

 Fecal:

 Other:

 Normal Diet:

 Any history of bites: [ ] yes TELL VETERINARY CREW & FIRST AID NOW! [ ] No

 Anything else we should know about this animal or this owner, use back of page if necessary:

 [ ] Check here if you have written on back of page