"Rescue Group - Record Keeping Form" - Georgia (United States)

Rescue Group - Record Keeping Form is a legal document that was released by the Georgia Department of Agriculture - a government authority operating within Georgia (United States).

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RESCUE GROUP – RECORD KEEPING FORM
Georgia Department of Agriculture (Hereinafter “GDA”)
[1] Please refer to the “Rescue Group – Information Sheet” for important information & instructions
[2] The current location must be recorded if the pet is not maintained at the address listed on the current
“GDA” animal shelter license. This information can be recorded in the comments area on this form.
Location name, physical address, and dates at the location must be included. A foster home location must
be recorded on foster home forms.
PLEASE PRINT ALL INFORMATION:
INCOMING RECORD (WHERE THE ANIMAL WAS ACQUIRED)
INCOMING DATE:
Animal I.D.
Animal
Number:
Type:
Animal
Description:
Name of Establishment or Person:
Phone Number:
GDA License Number:
Physical Address:
City:
State:
Zip:
MARK ONE OF THE FOLLOWING CATEGORIES THAT EXPLAINS HOW THE ANIMAL WAS ACQUIRED:
*
Impounding or harboring seized, stray, homeless, abandoned, or unwanted dogs, cats, and other animals:
Release of Custody/Ownership to Rescue Group:
Adoption:
Live Birth:
Custodial Care:
*
Impounding or harboring seized, stray, homeless, abandoned, or unwanted dogs, cats, and other animals requires a
contract with a “Political Subdivision of the State” “Ga. Animal Protection Act” 4-11-2(2).
OUTGOING RECORD (DESTINATION OF THE ABOVE ANIMAL)
OUTGOING DATE:
Name of Establishment or Person:
Phone Number:
GDA License Number:
Physical Address:
City:
State:
Zip:
MARK ONE OF THE FOLLOWING CATEGORIES THAT EXPLAINS THE FINAL DISPOSITION OF THE ANIMAL:
Rescue Group Release of Custody/Ownership:
Adoption:
Owner reclaim:
Deceased:
Euthanized:
Escaped:
Stolen:
Custodial care:
Comments:
RESCUE GROUP – RECORD KEEPING FORM
Georgia Department of Agriculture (Hereinafter “GDA”)
[1] Please refer to the “Rescue Group – Information Sheet” for important information & instructions
[2] The current location must be recorded if the pet is not maintained at the address listed on the current
“GDA” animal shelter license. This information can be recorded in the comments area on this form.
Location name, physical address, and dates at the location must be included. A foster home location must
be recorded on foster home forms.
PLEASE PRINT ALL INFORMATION:
INCOMING RECORD (WHERE THE ANIMAL WAS ACQUIRED)
INCOMING DATE:
Animal I.D.
Animal
Number:
Type:
Animal
Description:
Name of Establishment or Person:
Phone Number:
GDA License Number:
Physical Address:
City:
State:
Zip:
MARK ONE OF THE FOLLOWING CATEGORIES THAT EXPLAINS HOW THE ANIMAL WAS ACQUIRED:
*
Impounding or harboring seized, stray, homeless, abandoned, or unwanted dogs, cats, and other animals:
Release of Custody/Ownership to Rescue Group:
Adoption:
Live Birth:
Custodial Care:
*
Impounding or harboring seized, stray, homeless, abandoned, or unwanted dogs, cats, and other animals requires a
contract with a “Political Subdivision of the State” “Ga. Animal Protection Act” 4-11-2(2).
OUTGOING RECORD (DESTINATION OF THE ABOVE ANIMAL)
OUTGOING DATE:
Name of Establishment or Person:
Phone Number:
GDA License Number:
Physical Address:
City:
State:
Zip:
MARK ONE OF THE FOLLOWING CATEGORIES THAT EXPLAINS THE FINAL DISPOSITION OF THE ANIMAL:
Rescue Group Release of Custody/Ownership:
Adoption:
Owner reclaim:
Deceased:
Euthanized:
Escaped:
Stolen:
Custodial care:
Comments: