Intake Form - Lucky Chance Rescue
Click here to print the Intake Form or complete the form online below


keep, and maintain records or forms which fully and correctly disclose the following information concerning each dog or cat purchased or otherwise acquired, owned, held, or otherwise in his/her possession or control which is transported, euthanized, sold, or otherwise disposed of by that licensee. The records shall include any offspring born of any animal while in his/her possession or under his/her control:

  1. The name and complete mailing address of the person from whom a dog or cat was purchased or otherwise received or acquired whether or not the person is required to be licensed or registered under this Act;
  2. The USDA and the ACFA license or registration number of the person if s/he is licensed or registered under the Acts. Both USDA and ACFA numbers are required if seller is licensed or registered under both Acts;
  3. The vehicle license number and the state, and the driver’s license number and state if s/he is not licensed or registered under either of the Acts;
  4. The name and complete mailing address of the person to whom a dog or cat was sold, given, or delivered, and that person’s license or registration number(s) if s/he is licensed or registered under the Acts;
  5. The date a dog or cat was acquired or disposed of, or both, and the method of disposition, including by death or euthanasia;
  6. The official USDA or ACFA tag number or tattoo assigned to a dog or cat;
  7. A description of each dog or cat which shall include:
    1. The species and breed or type;
    2. The sex;
    3. The date of birth or approximate age; and
    4. The color and any distinctive markings;
  8. The method of transportation including the name of the initial carrier or intermediate handler or, if a privately owned vehicle is used to transport a dog or cat, the name of the owner of the privately owned vehicle; check to find out if this is only for transporting out of state/into state
  9. Individual medical records shall be maintained on all animals bought, raised, or otherwise obtained, held, kept, maintained, sold, donated, or otherwise disposed of, including by death or euthanasia, which shall specify all treatments and medications given and all procedures performed on the animal, to include reasons for or the condition requiring the treatment, medication, or procedure, and the results of the treatment, medication, or procedure will be included in this record. Litter health records may be kept on litters when all littermates are treated with the same medication or procedure. Medical records (or a copy) may accompany the animal when sold

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