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 PET WAS ACQUIRED)

Incoming Date

Pet I.D. Number

Pet Type

Pet Description

Name of Establishment or Person

Phone Number

GDA License Number

Physical Address

City

State

Zip

Select the category that explains how the pet was acquired

* 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 PET)

Outgoing Date