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 InformationName Type of Animal Age Sex Male Female Has your pet been spayed/neutered? Yes No Pet PhotoMax. file size: 20 MB.Physical Description My pet has: an identification tag a tattoo number a microchip Serial Number Where is the pet currently housed? Pet #1 Medical HistoryPlease provide a brief health history for your petDoes your pet have any recurring health problems? Yes No Please describe health problems:Is your pet currently on any medications? Yes No Please describe medications:Does your pet have any special dietary requirements? Yes No Please describe dietary requirements:Does your pet have any allergies to foods, medications or other substances? Yes No Please describe allergies:Veterinary Clinic Veterinarian's 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 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? Yes No Does your pet have free access to your home? Yes No Does your pet like children? Yes No What ages?Does your pet like other animals? Yes No Please explain:Does your pet have any favorite toys or possessions? Yes No Please describe the items and note where they are kept.Does your pet enjoy games such as fetch, tug-of-war, etc.? Yes No Please describePet #1 Special Care InstructionsPlease describe any special instructionsDo you want to add another pet?* Yes No Pet #2Name Type of Animal Age Sex Male Female Has your pet been spayed/neutered? Yes No Pet PhotoMax. file size: 20 MB.Physical Description My pet has: an identification tag a tattoo number a microchip Serial Number Where is the pet currently housed? Pet #2 Medical HistoryPlease provide a brief health history for your petDoes your pet have any recurring health problems? Yes No Please describe health problems:Is your pet currently on any medications? Yes No Please describe medications:Does your pet have any special dietary requirements? Yes No Please describe dietary requirements:Does your pet have any allergies to foods, medications or other substances? Yes No Please describe allergies:Veterinary Clinic Veterinarian's 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 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? Yes No Does your pet have free access to your home? Yes No Does your pet like children? Yes No What ages?Does your pet like other animals? Yes No Please explain:Does your pet have any favorite toys or possessions? Yes No Please describe the items and note where they are kept.Does your pet enjoy games such as fetch, tug-of-war, etc.? Yes No Please describePet #2 Special Care InstructionsPlease describe any special instructionsPet Guardianship (if already established)Name Email 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
