* Required
SCGRR Returned Dog
* 1. Dog’s SCGRR Name:
2. Dog's Current Name (if different):
* 3. SCGRR Tag #:
4. Breed:
5. Date dog returned (mm/dd/yy):
 
6. Age (Specify weeks, months, years):
7. Gender:

8. Microchip Company:
9. Microchip #:
10. Reason for return:
* 11.a. Owner's Last name:
* 11.b. Owner's First name:
11.c. Owner's Full Address (st, city, state, zip):
12. Known Medical Issues:
13. Known training and behavior with kids, cats, dogs, other:
14. Assigned Rep:
15. Fostered or Boarded By [Name and City]:
16. Intake Medical Costs (vaccinations, spay/neuter, exam):
17. Location of paperwork (name & phone or email):
18. Intake form submitted by (name/email):
19. Intake Volunteer (if different than submitter):
20. Other Notes:
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