Pet Intake Form - Cape Coral Animal Shelter

Name

This field is for validation purposes and should be left unchanged.

Owner Name(Required)

First Last

Today's Date(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Pet's Name(Required)

Pet Type(Required)

Feline

Canine

Breed(Required)

Color

Age/DOB(Required)

Sex(Required)

Male

Female

Fixed(Required)

Yes

Microchip(Required)

Yes

Microchip Number

Weight(Required)

Where did you acquire your pet?(Required)

Why are you surrendering your pet?(Required)

How long have you had your pet?(Required)

Is your animal current on Heartworm/Flea Prevention?(Required)

Yes

When last given?

Current Vet(Required)

Does your pet have any current or past health conditions or injuries?(Required)

My pet gets along with:(Required)

Men

Women

Children

Dogs

Cats

Check all that apply

(Children ages)(Required)

Has your pet ever shown signs of aggression?(Required)

Yes

If aggressive, please explain:

Does your pet live:(Required)

Indoors

Outdoors

check all that apply

Any destructive habits?(Required)

Yes

If destructive, please explain

Is your pet house broken/litter trained?(Required)

Yes

Please tell us about your pet and any special characteristics, personality traits or special needs:

Upload Recent Pet Photo

Max. file size: 10 MB.

Upload Pet Medical Records

Max. file size: 15 MB.

The cost to care for and re-home pets can be in the hundreds of dollars for each animal that comes into our care. CCAS is a private, non-profit organization that does not receive funding from national or government agencies. While we do not charge an owner surrender fee to take your pet into our care, if you would like to make a monetary donation to help subsidize the cost of your pet, we would greatly appreciate it. Recommended donation amount per dog is $100 and per cat is $50.00

Statement of Surrender

I certify that I ______ own the animal described above and hereby surrender all interest to the Cape Coral Animal Shelter. My interest in this animal has now been voided and I will not be given any information on the welfare or disposition of this animal.

Ownership(Required)

DO NOT

Initials(Required)

There is no minimum set time for holding this animal. The holding time depends on the animal's health, behavior and adoptability. It is also agreed that neither said shelter nor its management and employees shall incur any obligation to me on the disposition of the above listed animal.

Initials(Required)

I certify that this animal has not bitten another animal or human within the last 10 days.

Initials(Required)

I have read and understand that I have surrendered my rights and interest towards this animal.

Signature(Required)

Date(Required)

Adoption Information & Hours | 239-573-2002

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