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Shelter Transfer
Complete for Shelter Transfer to Lucky Chance Rescue
"
*
" indicates required fields
Shelter/Rescue Transfer
Animal Transfer To/From Lucky Chance Rescue
*
To Lucky Chance Rescue License #AC002QZ8
From Lucky Chance Rescue License #AC002QZ8
Shelter/Rescue Being Transferred To
Shelter / Rescue Name Transferred From
ACFA License #
Phone
Address
Street Address
City
State
Zip Code
Person Completing Shelter/Rescue Transfer
Transfer Date
*
MM slash DD slash YYYY
Single animal or litter of 2 or more?
*
Single
Litter
Litter and Mom
Species
Cat
Dog
Shelter / Rescue Animal ID#
Animal Name
Sex
Male
Female
Breed
Age (DOB)
Description
size, color, markings, distinguishing characteristics
Litter Information
Click + sign to add a new field for each animal
Species
ID#
Name
Sex
Breed
DOB/Age
Description
Add
Remove
Upload Photo(s) of Animal
Max. file size: 1 GB.
Shelter Info Sheet (if available)
Please upload info sheet so we have as much info as possible to find the best home
Drop files here or
Select files
Max. file size: 1 GB, Max. files: 10.
Animal Details
If info sheet is not available, please give us as much information as possible to ensure best placement.
Vetting History
Please check all that apply and provide any vet records upon transfer.
Spay/Neuter
Distemper
Bordetella
Rabies
Heartworm Test
Fecal Test
Microchip
Please list any/all health concerns
Does this animal have some form of ID? If yes, please describe below (collar, microchip, tattoo?)
Yes
No
If Yes, ID Type
To the best of your knowledge has this animal bitten anyone in the previous 10 days?
Yes
No
Was Transport Involved From Shelter/Rescue?
Yes
No
Transporter / Volunteer Name
Please list all transporters below, click the + symbol to add more.
Full Name
Phone Number
Vehicle License or Drivers License Number
Add
Remove
Shelter/Rescue Transport Information
Is animal being received from an out of state facility?
If animals are being received from out of state facilities, you must attach health certificates and rabies vaccination information.
Yes
No
Health Certificate and/ or Vet Records
Please upload copy and present original at Intake
Max. file size: 1 GB.
Rabies Vaccination Information
Max. file size: 1 GB.
Please upload copy and present original at Intake
Consent
I agree to the terms below
In the interest of saving animals, the above shelter/rescue wishes to enter into a Transfer Agreement with Lucky Chance Rescue. I hereby declare that I am an authorized representative for the above mentioned animal shelter, humane organization, or rescue group. I hereby declare that the transferring agency is transferring ownership; care and custody of the above mentioned animal(s) and hereby authorize the release of veterinary records of the above mentioned animal.
Signature of Authorized Representative
Lucky Chance Intake Info
Lucky Chance Admin
Person Completing Intake
Intake Date
*
MM slash DD slash YYYY
Single animal or litter of 2 or more?
*
Single
Litter
Mom and Litter
LCR Animal Information
Click + sign to add a new field for each animal
Species
ID#
Name
Sex
Breed
DOB/Age
Description
Add
Remove
LCR Animal Name
Rescue ID
Was Transport Involved?
Yes
No
Transporter / Volunteer Name
Please list all transporters below, click the + symbol to add more.
Full Name
Phone Number
Vehicle License or Drivers License Number
Add
Remove
Owner /Citizen Transport Information
Signature
*
Name
This field is for validation purposes and should be left unchanged.
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