Intake Please enable JavaScript in your browser to complete this form.Date of IntakeSOLAS File Number Assigned (to be filled out by SOLAS)Person Information (of person surrendering or finder)NameAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmailSurrender InformationReason for surrenderStrayOwner SurrenderTransfer from another rescue Temperment (check Shelter, If stray, area where the animal was foundWas animal checked for microchip?YesNoIf owner surrender, description of reason for surrenderingHow long have you had the animalAnimal Information (Fill in known information)Animal's NameSpeciesCatDogOtherBreedColor/ Markings/DescriptionApprox AgeKitten/PuppyYoung (1-3 years)Adult (4-7)Senior (8+)UnknownGenderMaleFemaleUnknownSpayed/Neutered?YesNoUnknownMicrochipped?YesNoUnknownMicrochip Number (if known)Animal HealthUp to date on vaccinations? YesNoUnknownApprox Date of last vet visitName of last vet seenKnown health issuesSkin conditionRespiratory ConditionVision or hearing issueInjuryChronic IllnessOtherIf yes to any of the above, please describe in detailList any current medicationsAnimal BehaviorHas animal shown signs of agressionYesNoIf yes to above, please describeTemperment (check all that apply)Friendly with adultsFriendly with kidsShy/timidFearful of strangersAggressivePlayfulHouse-trainedGood with catsGood with dogsDoes the animal have any of these known behavior issuesSeperation anxietyExcessive barking/meowingDestructive behaviorEscapingIs there anything else you want us to know about this animalRelease By signing below, I confirm that the information I have provided is accurate and complete to the best of my knowledge. I understand that once the animal is surrendered to S.O.L.A.S. Support Our Local Animal Shelter, the organization has the right to make decisions regarding the animal's care, adoption, or placement.Date / TimeSubmit
