Intake Request Form

Our shelter practices Managed Intake of animals whenever possible. Managed Intake allows us to schedule to incoming animals in order to increase the likelihood that every pet entering our facility is adopted to a new home. By allowing us to schedule intakes, this does several important things: Reduces the time the animal remains in the shelter before adoption. Reduces the likelihood that an animal displaying signs of a contagious disease enters the shelter unnecessarily, thus spreading illness and decreasing our adoption rates. Allows our staff to triage intakes, based on need and space available, thus increasing adoption rates. Allows us to estimate what needs the animal will have upon arrival, thus allowing us to adequately prepare. Reduces overcrowding at our shelter, which causes increases stress for both animals and staff, and leads to increases in illness. All of these things allows us to provide care in the best possible environment, and allows animals to live in a safe, comfortable and stress-free temporary home. Managed Intake allows us to provide the highest level of care for all animals that enter our program, and increases the likelihood that all animals will be adopted. Intake Policies: We accept animals from within the City of Bryant only. Animals from outside of our jurisdiction may be accepted on a case-by-case basis. If you need immediate assistance, you may contact the following organizations (this information is not a guarantee that any of them will accept the animal you are needing to place: Southern Hearts Rescue (501) 602-8037 Out of the Woods Rescue 501-503-0606 or 888-633-4442; email contact@ootwrescue.org CARE for Animals at 501-603-2273 or care@careforanimals.org Please complete this form in its entirety, being honest in answering the questions. The more information you provide, the greater the chances are that we can help you. In order for any intake to be processed the animal must be posted on the corresponding websites below: Found animals: https://lost.petcolove.org https://www.pawboost.com Animals that have been in your possession more than two weeks: https://home-home.org ***IMPORTANT: Knowingly providing false, inaccurate or misleading information on this document, form, correspondence, or in your conversations with any member of our staff is a crime, and may be prosecuted.***
Upload a picture of the animal you are requesting intake for. *
Completing this form does not entitle you to drop off an animal at our shelter. This form allows us to determine if and when we can accept the animal you wish to surrender to the shelter in the future. If this is an urgent or emergency situation, or the animal needs immediate medical care, please call us at 501-943-0489. The length of time you may have to wait before we can accept the animal depends on many factors. Please indicate that you have read, understand and acknowledge this statement.
*	I acknowledge and understand.
Intake Policies We accept animals from within the City of Bryant only. We accept animals only as space is available, unless emergency circumstances exist - if this is the case, please call the shelter at 501-943-0489 or the Bryant Police Dept at 501-943-0943 press 1. Knowingly providing false, inaccurate or misleading information on this document, or in your conversations with any member of our staff is a crime. We may consider accepting animals from outside of our jurisdiction on a case by case basis. The length of time you may have to wait before we can accept an animal depends on many factors. Please indicate that you have read, understand and acknowledge this statement.
*	I acknowledge and understand.
Species *	Armadillo Bat Bird Cat Chicken Chipmunk Cockatiel Coyote Deer Dog Donkey Duck Ferret Fox Gerbil Goat Goose Guinea Pig Hamster Horse Iguana Mouse Oppossum Other Owl Pig Pony Primate (Non-Human) Rabbit Raccoon Rat Skunk Snake Squirrel Terrapin Tortoise
Circumstances of Surrender *
Are you the legal owner of this animal? * The legal owner is described as someone who has the lawful authority to make treatment decisions, give the animal away or sell the animal.	Yes No Not sure if I am or not.
How did you obtain this animal? * Select the most appropriate answer, you will have an opportunity to explain in further detail later.	Found as a stray Wandered up to my house or business Taken in due to health, crisis or death of a friend/family member/neighbor/acquaintance Was abandoned at my home by the owner Adopted from another shelter or rescue organization Adopted from Bryant Animal Shelter Purchased from a breeder, individual or pet store Given to me Other
Area Found * We need the EXACT location of where the animal was found. Please provide the address (Including City and State,) intersection or business name - including City/State name. Stating "Walmart" with no other information is not sufficient because there are dozens of Walmart locations throughout Arkansas. We receive requests from all over the state, please be specific.
How did you obtain animal? *
When did this animal come into your possession? * Please answer by providing a date. If you cannot, please enter the amount of time the animal has been in your possession in days, weeks, months or years. If less than 1 day, please explain.
Has the animal bitten anyone in the last 14 days to the best of your knowledge? * Biting a person is not an indication of adaptability, all animals can bite. It merely tells us if we have other obligations and responsibilities under Arkansas State law.	NoYes
Is this animal sick or injured? *	NoYes
If yes, please explain. *
Number of animals animals requesting help for? *
What is the animal's name? * Enter "Unknown" if stray.
What Breed(s) is the animal? * If not sure, do the best you can.
Sex *	Male Female Unknown
Is the animal spayed or neutered? *	Yes No Unknown
What age is the animal? * If you aren't sure, take your best guess.	Younger than 3 weeks, needs bottle feeding Younger than 6 weeks, may need bottle feeding Between 6 weeks - 3 months, can eat solid food on its own Between 3 months - 5 months Between 5 months - 1 year Adult, between 1 year - 5 years Older adult, over 5 years of age
How sure are you of the age you selected in the previous question? *	Very certain - I know the exact age of this pet Certain - I have training/experience to be able to age a pet by its teeth Somewhat certain - I am fairly sure of my response Uncertain - It was a total guess
What is the primary reason you are needing to bring the pet to the shelter? *
TRAINING: Please check all the following that are true: *	Pet is leash trained (will not struggle or panic on a leash or collar) Pet is crate/kennel trained Pet is at least somewhat house trained Pet has attended obedience training in the past Understands "No!" Understands "Sit" Has additional training
Additional information about training: *
BEHAVIOR: Please check all the following that are true: *	Pet barks, growls or meows/yowls incessantly when left alone Pet has bitten a person and broken the skin in the last 2 weeks Pet has bitten a person and broken the skin at least once Gowls or snarls when playing or eating around people/animals Pet will contently chew appropriate items (rawhids, kongs, toys, etc.) Pet has damaged or destroyed items inappropriately (Such has clothes, shoes, furniture, etc.) Pet plays well with people and other animals Pet tolerates being picked up or demonstrates contentment when held Pet will amuse themselves when left alone with toys Pet growls, snarls, chases, swats at, hisses or bites/attempts to bite small children Pet growls at strangers Cat Only: Pet has hissed at someone in the household at least once in the past 2 weeks
Additional information about Behavior
REHOMING NEEDS: Please check all the following that are true: *	Does well with smaller children (younger than 5) Should NOT be in a home with small children Does well with other children (between 5-10) Should NOT be in a home with older children Does well with older adults (adults with mobility or balance problems) Should NOT be in a home with older adults Unknown
Additional information about Rehoming Needs:
Is there any other information you would like to provide about the animal's personality, behavior, health or rehoming needs?
Is the animal up to date on all its vaccinations, including rabies if over 3 months of age? *	Yes No Unknown
Can you provide documents to show proof of these vaccines? *	NoYes
At what clinic did the pet receive these vaccinations? Under what human's name is the pet listed under at the clinic? *
What is your first name *
What is your last name *
What is your home address? * Include Apt # and Lot #
City *
State *	AR AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zipcode *
Mobile Phone * We will email or call, but will not text.
Home Phone
What is your email address? * If you do not provide this information, we will not contact you.
Confirm email
Driver's License No *
Please submit a photo of your Driver's License or Identification. This ensures that the information you have provided is correct. This is not mandatory. Waiver, Release and Hold Harmless Agreement: 1. This may not be a secure network, and by submitting the requested documents, I state that I represent, covenant and agree, on behalf of myself and my heirs, assigns, and any other person claiming by, under or through me, as follows: I accept and voluntarily incur all risks of any injuries, damages, or harm which arise during or result from my submission and agree to hold harmless and/or its or their departments, trustees affiliates, employees, officers, agents or insurers (“Released Parties”). 2. I waive all claims against any of the Released Parties for any injuries, damages, losses or claims, whether known or unknown, which arise during or result from my submission, regardless of whether or not caused in whole or part by the negligence or fault of any of the Released Parties. I release and forever discharge the Released Parties from all such claims. 3. I agree to indemnify and hold the Released Parties harmless from all losses, liabilities, damages costs or expenses (including but not limited to reasonable attorneys’ fees and other litigation costs and expenses) incurred by any of the Released Parties as a result of any claims or suites that I (or anyone claiming by, under or through me) may bring against any of the Released Parties to recover any losses, liabilities, costs, damages, or expenses which arise during or result from my submission of such document, regardless of whether or not caused in whole or part by the negligence or other fault of any of the Released Parties. 4. I have carefully read and reviewed this Waiver, Release And Hold Harmless Agreement. I understand it fully and execute it voluntarily.
A member of our staff will be in contact with you within 30 days. Spring and Summer are our busiest seasons, it may take longer for us to reach out to you during these peak times. We are experiencing a large volume of requests and we are not a "no-kill" shelter. While we cannot guarantee that we can take in every pet that needs our help, we will consider each submission carefully, and respond to your inquiry as quickly as possible. IF THIS PET NEEDS IMMEDIATE EMERGENCY PLACEMENT, call us at 501-943-0439.