Your Name *

First Name

Last Name

Owner's Name (if different from above)

First Name

Last Name

What is your relationship with the dog? *

Owner

Pet Sitter

Foster

Rescue Organization

Shelter

Stray Dog

Dog Control/Law Enforcement

Other

Primary Phone *

(###)

###

####

I consent to receive text messages at the primary phone. *

Yes

No

Primary phone does not receive text messages.

Secondary Phone

(###)

###

####

I consent to receive text messages at the secondary phone.

Yes

No

Secondary phone does not receive text messages.

Date dog was lost? *

MM

DD

YYYY

Date of the most recent sighting of the dog?

MM

DD

YYYY

Have you reported the dog lost or missing to local Dog Control Services or law enforcement? *

Yes

No (please report the dog lost or missing ASAP)

Was the dog recently adopted or recently placed with a foster family? *

Yes

No

Unknown

Dog Gender *

Male

Female

Unknown

Is the dog microchipped? *

Yes (make sure the chip is registered and has your current contact info)

No

Unknown

Is the dog spayed/neutered? *

Yes

No

Unknown

Please check the box below to agree that you understand and acknowledge the following statement. *

I understand and acknowledge that the ability of Gatekeeper K9 Rescue (GKK9) to assist in finding my dog is limited by availability and location. GKK9 may be unable to provide assistance in finding my dog. If GKK9 provides assistance in finding my dog, no particular outcome is guaranteed.

Please check the box below to agree to the terms of our Release of Liability. Checking the box below is the legal equivalent of signing the release. *

I agree to release Gatekeeper K9 Rescue of liability as set forth in the document linked above ("Release of Liability").

Please check the box below to indicate your agreement with the following statement. *

I authorize Gatekeeper K9 Rescue to include information I provide on flyers, signs, and social media.