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Owner Surrender Evaluation Form
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Owner Surrender Evaluation Form
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11/13/2018 10:46:14 AM
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ASAB Agenda 101718
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\Advisory Boards and Commissions - Active\Animal Services Advisory Board\Agendas\2018
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<br /> <br />Page 2 of 2 <br /> <br />PART II: <br />Do you believe this person should not be allowed to adopt an animal from our shelter without consultation with staff <br />about animal care? Indicate below and note the reason(s) why you think there has been mistreatment. <br />Title Signature <br />YES <br />This person needs <br />consultation <br />NO <br />This person does not <br />need consultation <br />Attending Veterinarian <br />Notes: ____________________________________________________________________________________________ <br />__________________________________________________________________________________________________ <br />__________________________________________________________________________________________________ <br /> <br />Title Signature <br />YES <br />This person needs <br />consultation <br />NO <br />This person does not <br />need consultation <br />Animal Control Manager <br />Notes: ____________________________________________________________________________________________ <br />__________________________________________________________________________________________________ <br />__________________________________________________________________________________________________ <br /> <br />Title Signature <br />YES <br />This person needs <br />consultation <br />NO <br />This person does not <br />need consultation <br />Assistant Director OR Veterinary <br />Health Care Manager <br /> <br />Notes: ____________________________________________________________________________________________ <br />__________________________________________________________________________________________________ <br />__________________________________________________________________________________________________ <br />PART III: <br />Outcome: Allow adoption? Y N <br />Add “Do Not Adopt” icon to PID and memo: Name: ________________________________ Date: ________________
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