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Approve to Publish YesNo If you approve us to publish your complaint so that it will be visible to the general public on our website please check yes. Note that we will not publish personal/contact information about you, but we will publish your name.
First Name*
Last Name*
Your Phone*
Your Email*
Address Line 1*
Address Line 2
City*
State or Province —Please choose an option—AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon
Zip or Postal Code*
Country* CanadaUnited StatesOther
How should we contact you? E-mailPhone
Was this an online adoption? YesNo
Did you use financing? YesNo
Rescue Name*
Rescue Address Line 1*
Rescue Address Line 2
Name of rescue country if other?
Rescue Website
Rescue Email Address
Date of Adoption*
Adoption Fee*
Breed*
Sex* FemaleMale
Enter your best guess if you don't know the date of birth
Date of Birth or Approximate Age
Date of Death (if applicable)
Your rescued animal may have come from a puppy mill. It will help CAPS immeasurably in our investigations if you can provide information about the breeder and broker. It may be documented in your paperwork. Demand that the rescue provide this information.
Breeder
Breeder Address Line 1
Breeder Address Line 2
Breeder City
Breeder State or Province —Please choose an option—AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon
Breeder Zip or Postal Code
Breeder Country CanadaUnited StatesOther
If Breeder Country Other
Breeder Phone
Breeder Email
Breeder Website
Breeder USDA #
Broker
Broker Address Line 1
Broker Address Line 2
Broker City
Broker State or Province —Please choose an option—AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon
Broker Zip or Postal Code
Broker Country CanadaUnited StatesOther
If Broker Country Other
Broker Phone
Broker Email
Broker Website
Broker USDA #
Diseases and Illnesses*
When did illnesses begin and end?*
Hereditary Defects?
Did the rescue recommend a veterinarian?*
Veterinary expenses to date*
How did you hear about this rescue?*
Please describe the conditions at the adoption event or on transport van, such as housing, space availability, food, water, bedding, cleanliness, temperature, health and demeanor of the animals, and exposure to illness and disease:
Enter Description Here*
