Name of Person Completing this form:

Rescue Date:
Silky's Name:

Silky's Age:


Location of Rescue (state):

Rescued From?: 
 Owner Turn In
 Shelter 
 Stray 
Other


If Rescued From - Other, Specify:


Silky's Gender:
 Male, Intact 
 Male, Neutered
 Female, Intact
 Female, Spayed



Reason in Rescue (check all that apply):
Owner ill or deceased
Stray
Behavior Problem
Housetraining Problem  
Doesn't like kids
Aggressive
Doesn't get along with other dogs
Other

If Other Reason in Rescue, Specify:





Comments or Notes: