Pet OwnerEmail* First Name*Last Name*Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile Phone NumberHome Phone NumberWork Phone NumberIn the event of illness or death, I have made arrangements for the care of my pets with: The Dumb Friends League, 2080 S. Quebec St., Denver, CO 80231 The person(s) listed below Pet InformationNameType of AnimalAgeSexMaleFemaleHas your pet been spayed/neutered?YesNoPet PhotoPhysical DescriptionMy pet has: an identification tag a tattoo number a microchip Serial NumberWhere is the pet currently housed?Pet #1 Medical HistoryPlease provide a brief health history for your petDoes your pet have any recurring health problems?YesNoPlease describe health problems:Is your pet currently on any medications?YesNoPlease describe medications:Does your pet have any special dietary requirements?YesNoPlease describe dietary requirements:Does your pet have any allergies to foods, medications or other substances?YesNoPlease describe allergies:Veterinary ClinicVeterinarian's NameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberWebsite Pet #1 Behavioral InformationPlease describe your pet’s preferences, dislikes, phobias or habitsPlease list verbal and nonverbal commands your pet responds to, as well as body language used to communicateDoes your pet respond to routine commands such as “sit,” “stay” or “down”? If so, please list them.What is your pet’s daily routine? (Examples: walking, feeding, playing, bedtime, etc.)Is your pet allowed outside?YesNoDoes your pet have free access to your home?YesNoDoes your pet like children?YesNoWhat ages?Does your pet like other animals?YesNoPlease explain:Does your pet have any favorite toys or possessions?YesNoPlease describe the items and note where they are kept.Does your pet enjoy games such as fetch, tug-of-war, etc.?YesNoPlease describePet #1 Special Care InstructionsPlease describe any special instructionsDo you want to add another pet?*YesNoPet #2NameType of AnimalAgeSexMaleFemaleHas your pet been spayed/neutered?YesNoPet PhotoPhysical DescriptionMy pet has: an identification tag a tattoo number a microchip Serial NumberWhere is the pet currently housed?Pet #2 Medical HistoryPlease provide a brief health history for your petDoes your pet have any recurring health problems?YesNoPlease describe health problems:Is your pet currently on any medications?YesNoPlease describe medications:Does your pet have any special dietary requirements?YesNoPlease describe dietary requirements:Does your pet have any allergies to foods, medications or other substances?YesNoPlease describe allergies:Veterinary ClinicVeterinarian's NameAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberWebsite Pet #2 Behavioral InformationPlease describe your pet’s preferences, dislikes, phobias or habitsPlease list verbal and nonverbal commands your pet responds to, as well as body language used to communicateDoes your pet respond to routine commands such as “sit,” “stay” or “down”? If so, please list them.What is your pet’s daily routine? (Examples: walking, feeding, playing, bedtime, etc.)Is your pet allowed outside?YesNoDoes your pet have free access to your home?YesNoDoes your pet like children?YesNoWhat ages?Does your pet like other animals?YesNoPlease explain:Does your pet have any favorite toys or possessions?YesNoPlease describe the items and note where they are kept.Does your pet enjoy games such as fetch, tug-of-war, etc.?YesNoPlease describePet #2 Special Care InstructionsPlease describe any special instructionsPet Guardianship (if already established)NameEmail Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile Phone NumberAlternate Phone NumberAdmin Use OnlyDonorIDRaiser's Edge ID
