Animal Description:

Name

Color

Species

Breed

Gender

Age

Micro-chip#

OK with kids?
[ ] Yes [ ] No

OK with other animals?
[ ] Yes [ ] No

Medical problem?
[ ] Yes [ ] No

Cats, cage birds, pocket pets, and others as specified must be kept inside the house.

Foster Care Premise:

Owner:

Phone#:

Email:

Address:

Fenced yard/paddock [ ] Yes [ ] No - if no, this premise may not foster outside animals

Shelter from sun/rain: [ ] Yes [ ] No - if no, this premise may not foster outside animals

Children in home: [ ] Yes [ ] No

Other animals in home [ ] Yes [ ] No

Signature of foster care provider:

ARG# if member:

ARG Veterinarian statement:

HWT results: [ ] Pos [ ] Neg Treated with:

Coggins results: [ ] Pos [ ] Neg N.B. EIA is reportable

FeLV results: [ ] Pos [ ] Neg Vaccination status:

FIV results: [ ] Pos [ ] Neg

Vaccination status:

Fecal results: [ ] Pos for       [ ] Neg

Treated with:

Rabies vaccination status:

Other vaccinations given:

Other health information:

Medications:

Inside only or other specifications:

Veterinarian's signature:

License #:

Has the owner of this animal been confirmed? [ ] Yes   [ ] No
If yes:

Owner's name:

Contact phone:

Contact email:

Contact address:

Expected duration of foster care:

Reason for foster care:

Owner's signature:

Date:

If owner is not known, we will continue to attempt to find the owner and reunite them with this animal. If owner is not found within 180 days from the date of admission to ARG care, or if owner relinquishes this animal's ownership to ARG, this animal will be available for adoption.

First in line to adopt:

Name

Mailing Address

Phone#

Email

Second in line to adopt:

Name

Mailing Address

Phone#

Email

Third in line to adopt:

Name

Mailing Address

Phone#

Email