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Kamloops and District Elizabeth Fry Society
Kamloops and District Elizabeth Fry Society
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Pet Application - New Item
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There are items in this form that require your attention
Name of Applicant
*
Individual
Do you currently reside with KDEFS/KEFHS?
None
Yes
No
Building
None
Elizabeth Court
Hilltop
Corner House
Penny's Place 127
Penny's Place 165
Unit Number
Emergency Contact name
Emergency Contact phone
Veterinarian Name
Veterinarian Office Name and Phone
Pet Information
give details including name of pet, type, breed, age, weight, height/size, whether they are spayed/neutered
City of Kamloops registration #
Do you have ownership papers such as vet records, adoption, or purchase documentation? If yes, please provide a copy
None
Yes
No
Are your pets' vaccinations current?
None
Yes
No
Do you have records for those vaccinations?
None
Yes
No
Vet records are to be attached to the application
If no, allow KDEFS staff to contact your veterinarian to obtain records on your pet(s)?
None
Yes
No
Is the pet you are applying for an exotic pet?
None
Yes
No
Is your pet legal in Canada?
None
Yes
No
Have your cats been tested for feline leukemia and feline immunodeficiency virus?
None
Yes
No
N/A
Results and date:
List any behavioural issues with your cat(s) (eg. excessive noise, aggression, fearful of strangers, separation anxiety, etc.)
Do your cats have any medical conditions?
None
Yes
No
N/A
If yes, please describe the ailments and current treatment:
How have your cats been housed at your home?
None
crate-trained
indoor/outdoor
outdoor only
indoor only
N/A
Have your cats received flea/tick/parasite prevention treatment yearly?
None
Yes
No
N/A
Have your dogs been tested for heartworm?
None
Yes
No
N/A
if yes, results and date:
List any behavioural issues with your dog(s) (eg. excessive noise, aggression, fearful of strangers, separation anxiety, etc.)
Do your dogs have any medical conditions?
None
Yes
No
N/A
If yes, please describe the ailment and current treatment:
How have your dogs been housed at your home?
None
crate-trained
indoor/outdoor
outdoor only
N/A
Have your dogs received flea/tick/parasite prevention treatment yearly?
None
Yes
No
N/A
Are your dogs house-trained?
None
Yes
No
N/A
Have your dogs bitten anyone?
None
Yes
No
N/A
if yes, describe the circumstances (including the date the bite(s) occured):
How does your dog(s) interact with other animals? Please explain:
Has your dog(s) been aggressive towards other animals or humans?
None
Yes
No
N/A
If yes, please describe the circumstances:
Are your dogs loud and/or do they bark frequently?
None
Yes
No
N/A
How many fish do you have?
How big is your fish tank?
Sign in the large box or type name in the smaller box below
Signature
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