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Pet Transfer Form

Date

Month

Day

Year

Name*

Phone*

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

If caretaker is different from owner:

Caretakers name

Caretakers relationship to owner

Caretakers address

Caretakers phone

Caretakers email

Do you have the authority to transfer the pet into CAC's care for fostering and adoption? Explain*

Owner's status:

Hospice

Nursing Home

Memory Care

Assisted Living

Rehab

Deceased

Other

Pet name*

Age/ Date of Birth*

Pet Breed*

Pets Weight (Approx)*

Veterinarian's Name

Veterinarian's Phone Number

Is the pet current on all vaccinations?

Yes

No

Markings

Is your pet micro chipped?*

No

Yes

Did you get your pet from a rescue or shelter?*

No

Yes

Does this rescue/shelter have claim to this pet?

No

Yes

Is/does this pet:*

Completely housebroken

Paper-trained

Crate/ Litter trained

Have accidents

Where did the pet sleep at night*

Kept during the day*

How does the pet behave when alone*

Was the pet confined to your property*

Fenced area

Cable/ chain

Not confined

Does the pet jump fences*

No

Yes

Pets favorite activity*

Has the pet lived with other

Dogs

Cats

Birds

Children

Other

How did this pet get along with family members/ children*

Anything else you'd like to tell us

Signature*

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Phone

Companion Animal Care (CAC) of Brevard County, FL ministers to those living on the Space Coast.

We are an approved I.R.S. 501(c)3 tax exempt nonprofit.

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