First Name*
Last Name*
Address
City
State/Province
Zip/Postal Code -
Email*
Home Phone
Work Phone x
Cell Phone
Mailing Address if Different from Above
Profile Form Date
Can you keep the pet until it is adopted?
About the Pet
Pet Name:
Rescue ID (EAPL admin use only)
Pet Gender
Pet Species:
If other, please describe:
Foster (EAPL admin use only)
Does your pet have special needs
What Breed is your pet
Color (general):
Weight (pounds):
Birthdate (exact or estimate):
Age
Reason you are giving up the pet:
Did the pet come from out-of-state?
If so, which state?
Medical Information
Vet Name:
Vet Phone:
Is the pet spayed or neutered?
Alter date
When are the next shots due?
When is the rabies shot due?
Does the pet have any old injuries or health problems?
If yes, please describe:
Does the pet need any medication or special diet?:
When was the pet usually fed:
Living Environment
Pet Time With You:
Where Acquired:
Where Allowed:
How much of the time was the pet outside?
How much of the time was the pet inside?
Where did you leave the pet when you were gone?
Where did you leave the pet when you were gone on holiday/vacation?
Hours Unsupervised:
Where does the pet usually sleep?
Is this pet a fence jumper?
If yes, how high is the fence?
If yes, of what material is the fence made?
Does the pet repeatedly escape from your yard (dogs)?
If yes, when does the pet try to escape?
Training Type:
Does the pet know how to:
Does the pet do any tricks?
Is the pet house trained?
If not house trained, has the pet been seen by a vet to rule out physical issues?
Has Accidents:
Is the pet crate trained?
(Dogs) Is the pet leash trained?
(Dogs) Lunges at Dogs When Leashed?
(Dogs) Lunges at People When Leashed?
(Dogs) Lunges To Play?
Behavior
Has the pet ever bitten, snapped or growled?
Bad Habits:
what have you done to correct it?
Is a Barker:
Barks When:
Frightened by anything?
Aggressive Towards Anything?
Aggressive Towards:
Gets Along With:
Gets Along with Comments:
Good With Children:
Good With Children Comments:
Is Overprotective:
Has Favorite Toys:
Best Situation:
Administrative Use
EAPL Tag Number:
form completed
EAPL Representative Who talked to you:
EAPL Representative Comments:
ID Choose an animal: Abby Aberdeen Abigail Absinthe Ace Ace Addie Addison Drake Adele Adele Akira Alani Alder Alfred Alice Alley, Ally Almond Amaryllis Amber Angel Angelina Angus Annabelle Annalise Anne Annie Annie Aphrodite Apollo Apples Archie Ari Ariel Ariel - special needs Aries Ark Artemis Arthur Aruba Arya Asher Ashlee Ashlyn Ashton Ashton 2018 Aslan Aspen Aspen/Kona Aster Asteroid Athena Athena Athena Athena Atlas Atom August Aurora Grace Autumn Autumn Avocado Babs Babs Baby Baby Cat Baby Ruth Baby-Girl Babycakes Bailey Bailey Bailey Bailey 2016 Bambi Bambino Bandit Bandit, courtesy listing Barney Barney Basil Basket Batman Baxter Baxter Baylee Bean Beanie Baby, Declawed Bear Beatrice Beetle Bella Bella Bella Bella Bella bella 2 Bella of Bella and Lola Benjamin Benjamin Benji Bentley Benton Berkley Bermuda Bernie Beso Betsy - special needs Betty Betty Betty Bianca Biebers Big John Big Mac Bill Billy Boy Billy Buttons Billy Joe Billy the Kidd Bindi/Sydney Bingo Bingo Biscuit Biscuit Blair Blake Blanche Blitz Bloom Blue Blue Baby Blue Cat Blue Eyes Blue II Blue Moon Bluebell Blueberry Blueberry 2019 Bob Bobbie Bobbie Jo Bobby Bobkat, Bodi Bodie Bojangles Bolo Bolton Bon Bon Bonaire Bonnet Boo Boo - declawed Boo Boo Boo Boo Cheddar Booker Boomer Bootercup Boots Bootz, Bordeau Bounce, Boyington Breelyn Briar Bridgette Brio Bristol Brooke Brooklyn Brownie Brownie Bruce Brulee Brutus Brynn Bubba Bubbles Bud Buddy Buddy Buddy the 5th Buffy Bug Bugg Bugs Bumble Bee Bunny Bunny Bunny Manx Bunny/Dove Burke Burke Burrito Buster Buster Buster Butch Butterball Buttercup Butterfly Butterfly Butterscotch Butterscotch Button Buzz C C, C3PO Cabernet Cadence Cadwaller Caesar Cai Cali Callie Cally Calypso Cameo Camilla Candi Candy Candy Tuxedo Canon Canon City Cappuccino Cappuccino Capt. America Captain Cara Carly Carmi Carnation Caroline Case Casey Casey Cash Casper Casper Cassidy Cassie Cassie Catlyn Catnip Catrick Swayze Cayenne Celia Celine Celine Chad/Oscar Chamomile Chance Chanel Chaos Chardonnay Charlee Charlee Charlene Charlie Charlize Charm Charm Cheddar Cheetoez Chelsea (aka Beauty) Cherry Chervil Chervil Chester Chester Chester (Crank) Chewy Chewy Chewy Chiclet Chico / Ashton Chicory Chloe Chloe Chocolate Choo Choo Christian Cici Cilantro Cilantro Cilantro Cinder Cinderella Cindy Cindy Lou Who Cinnamon Cinnamon Cinnamon Clancy Clara Clare Clarence Clarissa Clark Clark Claudette Clawdia Clementine Clementine Cleo Cleo Cletus Clint Cloud Cloud Clove Clove Female Clover Clover Clover Cloverfield Clue Cobweb Coco Coco Coconut Coconut (2) Cohen Col. Mustard Cola Colby Collette Collier Collin Colorado Colton Comet Comet Comet Commitment Confetti Connor Cookie Cookie Cookie Cooper Cooper Cooper Coors Copper Cordelia Coriander Cork Corteney Cory Cotton Cotton Candy/Gypsy Cougar Courage Courage Crackle Crash Cream Pie Cree Cricket Cricket Cricket Crickett Cristo Crookshanks Cubie Cuddle Buddy Cuddles Cuervo Cumin Cupcake Cupcake Cupid Curacao Curly Custard Custer Daffodil Daffodil Dagger Daisy Daisy Mae Daisy May Daja Daley / Prince Dalia Dandelion Dani Daniella Dante Daredevil Dark Chocolate Darling Dartanion Dash Dasher Dasher Dawn Dawson Daytona Dean Delise Dempsey Dena Denali Derby Derby Derick Derry Desi Deuce Diamond Diamond Diamonds Diana Diego Diesel Ding Dong Dinky Dinky Sissy Dior Dixie Doc Dodge Dodger/Gage Doe Dolly Domi Don Juan (DJ) Donegal Donegal (2) Donita Donnie Doodle Doolittle Dora Dot Dove Dozer - special needs Dr. Whiskers Dragon Dragonfly Dreamsicle Drew Dublin Duchess Duckling Ducky RS LTF Dudley Dugan Dumbledore Dumpling Duncan Dutch Ean Earth Easter Easton Ebony Ebony Ebony Ebony Eclipse Ed Eddy Edwin Eevee Einstein Elaine Elara Elektra Eli Ellie Elliot Ellis Elsa Elton Ember Emily Emily Emma Enzo, Epson Esmerelda (goes with Jasmine) Esperanza Espresso Ethan Ethel Evan Fairbanks Faith Fallon Fanny Farley & Freda, - foster or adopter needed Farquad Fathom Faust Fawn Feather Feather Feisty Feisty Felix Fenway Fey Fig Finch Finch Finneas Finnegan Finnian Fiona Firefly Fishstick Fannie Flora Flower Floyd Fluffy Fluffy, Flynn Flynn Foxworthy Fradey Fran Francine, Francisca Frank-E Franny Frazier Freckles Freckles/Zoey Fred Freddy - special needs Fredericka Fredericka Freedom Freeman Frenchie Freya Fritzie Frog Gage Galahad Galaxy Gambler Gandalf Garway Garway Gatsby Gayla Gelato Gemma Genoa Gentle Ben George George Georgette Georgia Geronimo Ghost Ghost Gigi Gilpin Gimlet Gingerbread Giselle Glasgow Glory Goober Gracie Gracie Gracie Grasshopper Gravy Graycie Grayson Gretel Grey Grey Griffin Grigio Gryffindor Guiness Guinevere Guinness Gumdrop Gumdrop Gus Häagen-Dazs Haley/Bailey Hallie Hallow Hansel Harlee Harley Harold Harper Harry Hawk Hayden Haze Hazel / Penny Heath Hemingway Henry Herbie Hermione Hex Hocus Homer (Homeless) Honey Honeybun Honeydew Hoot Houdini - foster or adopter needed Hufflepuff Hyde Icicle Iclynn Idell Igloo Ilsa (Lila) Imara Inara Independence India Indy Inky Ireland Iris Iris Iris, Irish Iron Man Irving Islay Itchy Ivan Ivie Ivy - medical Izzy Jacee Jacinta Jack Jack Jack Jackie Jackson Jackson Jackson Moss Jade Jade Jamaica Jameson Jamie Jammin Janie Jared Jasmine Jasmine Jasmine (goes with Esmerelda) Jason Jasper Jax Jax Jax Jay Jaylin Jazlyn Jazz Jazzie Jellybean Jemmie Jennie Jenny Jerek Jesse Jesse James Jet Jetta Jewel Jewel Jill jill, Jill/Bella Jimmy Jinx, Polydactyl Joey John Paul Johnny Johnny Jolene Jonas Jordan - special needs Josey Josie Josie Joslynn - special needs Julian Juliet Juneau, Juno, URGENT Foster Needed Jupiter Jupiter Justice Justin Kaari Kai Kai Kai (Mortimer) Kalinda Kally Kam Kara Kat Kat Katana Katana Kate Katie Katie Katniss Kato Kato Kato Kayla Kaylee Kayleigh Keanu Keaton Kedi Bear Keely Keena Keira Kelly Kenai Kenzie Kettles Khaki Kiefer Kiki Kiki Kilarney Kildare Kilkenny Killian Kim Possible Kinsey Kiska Kissy Kissy's Pups 4-5 wks Needs Foster Kit Kit Kit KitKat Kitten Adams Kitten Adriana Kitten Alamosa Kitten Albus Kitten Anastasia, Kitten Animas Kitten Annie Kitten Arapahoe Kitten Beau Kitten Bert Kitten Bertie, Kitten Billy Bones Kitten Blackbeard Kitten Butterfly Kitten Carter Kitten Charming Kitten Dakota Kitten Deon Kitten Drake Kitten Eleanor Kitten Ernie Kitten Fairy Kitten Fiona Kitten Flint, Polydactyl Kitten Ford Kitten Galaxy Kitten Gandalph Kitten Georgie Kitten Hourglass Kitten Jafar Kitten Jay Kitten John John Kitten Kennedy Kitten Lark Kitten Leopard Kitten Merlin Kitten Mia Kitten Morgana Kitten Paulie Kitten Peanut Kitten Raven Kitten Reagan Kitten Ringo Kitten Robin, Polydactyl Kitten Shiro Kitten Shooting Star Kitten Silver Kitten Simee Kitten Sparrow Kitten Spot Kitten Sundown Kitten Titan Kitten Tori Kitten Truman Kitten Twilight Kitten Ty Kitten Vain Kitten Wren Kiwi Kodiak Kohl Koji Kola Kome Kottonwood Krangis Kristoff Lacey Lady Jane Ladybug Ladybug Lancelot Landon Langdon Lannister Larry Larry, the Female Latte Latte Latte Lea Lee Leela Lemon Lenora Leo Leo Leon Leonardo Leopold Leroy Leroy Lewis Lexi Lexi Liama Libby Lili Lille Lilly Lilly (9 Yrs.) Lilo Lily Lily Lily (2) Limerick Limerick Limerick Linc Lindbergh Link Linus Little Lady Midnight Little Princess Livie Livorno Liza Liza Lizzie Logan Lokie Lola Lola - Declawed Lola of Bella and Lola Lolly London London Loona Loretta Louis Louise Louise Louisiana Love Bug Lucas Lucas Lucinda Lucy Lucy Lucy Dakota Lucy Declaw Lucy II Lucy, Polydactyl Luigi Lula Luna Luna Luna Luna Luna Belle Luna1 Lyndsey Lynx Lynx Lyon Lysa M&M Macaroni Macchiato Maddox Maddox Madea Madge Mae, URGENT Foster Needed Maggie Maggie Magnolia Magnum Magnum Maia Maisey Maisy Maizie Malcolm Malia Mama Mama Nina Mamie Mandalay Mango Mango Mannie Manny Mantis Maple Marble Marble Marble Cake Marcie Marco Marcus Marcy Margo Marida Marigold Marigold Mario Marley Marni Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Mars Martell Martha Marti Martin Marty Marx Mary Marybelle Mason Mason Mason Mateo Matilda Matisse Matteo Maude Maura Max Max Max Maya Mazikeen McKinley Mercedes Mercedes Mercedes Mercedes Mercury Mercury Meredith Grey Merida Merlin Merlin Merlin - special needs Mermaid Meryl Meya - cataracts Mia Mia Mickey (Dorito) Midnight 2016 Midnight 2018 Midnight 2019 Midnight, Milano Mildred Milk Chocolate Millie Millie Milly Milton Mimi Mina Mini Miss Kitty Miss Kitty Miss Kitty Missy Missy Missy (2021) Mister Mistletoe Misty Mitch Mitchell Mittens Mo Moana Moana Moana Moana Mocha Mocha Molly Molly Monkey Monkey Monkey, Declawed Monopoly Monroe Monty Moonlight Moose Morgan Morgana morris Morris Moses Mousse Moxie Mr Cannoli aka Clifford Mr Pug Mr. Body Mr. Green Mr. Kelly Mr. Peacock Mrs. Claus Mrs. Kitty Kitty Muffin Muffin - Polydactyl Mugsly Mumba Munkie Murdock Murphy Murphy Mystery Mystic Nacho Naples Natalie Nate Nathan Nebulae Ned Ned Neferkitty Nellie Nelson Neptune Neptune Neptune new mexico pup caris, Newton Nibbles Nick Niki Niles Nimi Nimue Nioshi Nita Nonny - medical Noodle Noodles Norman Nova O'Hara O'Malley O'Malley O'Shea Oakie Oakley Odin Olive Oliver Oliver Oliver Olivia Omari Omi Onan Oniji Onya Onyx Onyx Oreo Oreo Oriana Orion Orion Oscar Oscar Ottis Ouray Owl Owlette Owliver Owlivia Paddington Paisley Paisley Palmer Paloma Pan Pancake Panda Bear Pandora Papaya Parcheesi Paris Paris Parker Parrot Patch Patsy Patunia Pauley PB (Paintbrush) Peach Peaches Peanut Peanut Peanut Brittle/Lassen Pearl Pecan Penne Penny Penny Penny / Tui Pepita Pepper Pepper Peppercorn Peppermint Peppermint Patty Peppi Pepsi Perogie Persephone Persimmon Pesky Phantom Phantom Phil Philly Phoebe Phoebe, Phoebe, Picachu Picala Picasso Pika Pikachu (Adult) Pikle Pinot Piper Piper Piranha Pixel Pixie Pixie Pixie PJ Plum Pluto Pluto Pocus Poker Polar Bear Polly Polly Pookie Pookie * sponsored adoption fee Pop Popcorn Popper Poppet Poppet Poppy Poppy Poppy Seed Popsicle Popsicle Porcupine Porridge Porsche Poseiden Posy Pot-O-Gold Prancer Prancer Precious Precious Pree Presley Prince Prince Adam Princess Princess Princess Princess, Princeton Princeton Priscilla Puck Puck Pudge Puff Puffin Pumpkin Pumpkin Pie Punkin Q-Tip Queenie Queenie II Queso, Quinn Quinton R2D2 Rachel Rachel Rachel aka orphan Annie Rackham Raffles Raggedy Andy Rainey Rajah Rambler Randall Rascal Rascal Rascal Rascal / Maximillion Raven Raven Ravenclaw Ravioli Ravyn Rebel Red Red Panda Reddington Reese Reggie Reggie Regina Reilly Reisling Ren Reyna (Cinderella) Rico Rider Rigatoni Rikki Riley Riley Ringo Rio Ritchie River Rivers Robbie Rock Rocket Rocky Rocky Rocky Rocky LT LTF Roll Roma Ron Rona Ronda Rori Rosa Rose Rose Rose Rosemary Rosey Rosie Rosie Rosie Rotini Rowena Ruby Ruffles Ruffnut Rumba Rumble Rummy Ryker Ryker, Ryland Sabrina Sacramento Saffron Sagebrush Sally Sally Salsa Salty Willow Sam Sam Sami Sammy Sammy - Adult Samsa Samson Samsung Sandy Sandy Sansa Santa Claus Sara Sarafina Sarah Sasha Sasha Sasha II Sassafras Sassie Sassy Sr. Sassy, Saturn Saturn Saucy Scarecrow Schatzie Scooter Scooter Scout Scrabble Sebastian Sebby (Buzz) Severus Sevro * sponsored adoption fee Seward, Shadow Shalimar Sheila Shelby Sheridan Sherlock Sherlock Shiitake Shiner Shinju Shortstop Shuri Sidney Sierra Simba, Sr. Simon Sinatra Sissie Sissy Skeeter Sketch, Skittles Sky Sky Rocket Skye Skye Skye Skylar Skylar Slim Slytherin Smidge Smoke Smoke Smokey Smokey Smokey, Smooch Smudge Smudge Snap Snickers Snickett Snoopy Snow Lily Snow White Snowball Snowball Snowy Somers Sonny Sophia Spades Sparkler Sparrow Spartan Spearmint Specs Speedy Spencer - medical - needs foster or adopter Spice Spider Spike Spike Spinner Spots (Kitten Elk) Spotsy Spring Sprinkles Sprocket Sprout Sprout Squirt Squirt Squishy Face Brownie St. Nick Stanley Star Star Star Stark Stella Stella, Adult Stetson Steve Stevie Stewart Stickshift Stitch Stoic Storm Stormy Strawberry Strawberry Streak Stripe Subie Sugar Sugar Baby Summer Summit Sun Sunny Sunny Supergirl Sushi Swan Sweet Pea Sweet Pea Sweetie Sweetie Sweetie Pie Sweetie Pie Sweettarts Syberia Sylvester Sylvester Sylvester Sylvester Sylvia Syrah Tabitha Tabitha Tabitha Taco Tai Takeo Tamale Tangie Tango Tango Tank - forever foster medical Tanner Tanner Taquito Tara Tara Reid Tara/Matia Tate Tatum Tay Tay Taylor Taz Tebow Teddy Teddy Teller Thelma Thelma Theo Theo Thirteen Thomas Thomas Jefferson - "TJ" Thor Thor Thor Thora Thumper Tiana Tick Tiffany Tiffany Tiger Tiger Tiger Tiger Tigger Tigger Tigger1 Tim Timmy Tina Tink Tinkerbelle Tinks Tinsley Tiny Tim Tiramisu Tivoli Tiz Wiz Tolstoy Tom Tomatillo Tomkat, Toner Tony Tony Toolie Toots Toshi Toshi Tostada Totoro Traveler Tres - special needs Treva Trevor Trevor Tricia Tricks / Oliver Trinket Trudy - special needs Truffles Truman Tubs Tucker Tucker Tucker Tuffnut Tuffnut Tulip Tulip Tulip B/W Tuna Turbo Tux Tuxedo Tuxi Tweedle 2 Tweedle Dee Twiggy Twilight Twinkie Twitter Twix Twyla Tyson Tyson Ulysses Umberto Uni Unice Unicorn Uno Uri Ursula Valentina Valentino Valka Vanessa Vanilla Venus Venus * sponsored adoption fee Verona Veronica Vienna Vin Vincent Vincent II Viola Violin Vixen Vixen Von Wadsworth Wadsworth 2018 Walter Walter Wanda Warrier Watson Watson/Kato Watts Weasley Wendy Wesley Wesley Whiskers White Chocolate White Cloud Whitney Willa/Stella Willow Willow Willow Wilma Winnifred Winter Wintergreen Wire-hair Daisy, Wookie xena - special needs Yager Yahtzee Yancy Yang Yani Yarrow Yasmine Yasmine Yeti Ying Yingling Yoda Yogi Yookie Yorrie Yoshi Yuna Yvetta Zane Zappa Zara Zara Zara Zario Zatti Zelda Zeus Zeus Zeus (Adult) Ziggy Zinger Zinnia Zion Zippy Zoe Zooey Zooey Zuni Zuri