Temporary Care Application Pet Owner Information Full Name * First Name Last Name Email * Phone * (###) ### #### Address * Emergency Contact Emergency Contact Information * Someone who can make decisions if you are not available. * Second Emergency Contact Information * * Pet Information Pet Name * Species/Breed? * Age? Spayed/Neutered? * Yes No Microchipped? * Yes No Veterinarian's Office * Name and Phone Number This Pet Is Up-To-Date on These Vaccines/Medications: Rabies Bordetella Flea & Tick Prevention DHPP (Distemper, Hepatits, Parvovirus, Parainfluenza) Leptospirosis Any Health/Behavioral Needs We Need To Know About? Any Personal Items That Will be Coming With Your Pet? (Food, toys, bedding, etc) Is Your Pet Comfortable with Cats, Dogs, Children, Men? Any situations that your pet is not comfortable with? What occurs when they are in those situations? Anything Else We Need to Know About Your Pet? Do you have additional pets? * Yes No I understand that: * 1. Paws Until Home is able to provide care for 30-days. If pets are not reclaimed by the thirty seventh (37th) day, they may be surrendered to a local rescue or put up for adoption 2. In the case of a medical emergency, owners will be responsible for any costs associated with veterinary care 3. Pets are expected to be up to date on Rabies vaccinations and flea and tick medication. If pets are not, they may need to be given these 4. Submitting this form is not a guarantee of care. Paws Until Home may need to coordinate with partners and fosters before physical intake of pets I Understand Thank you! We will be in contact with you soon.
