Surrender Request Form
Please fill out the following form to submit a request for an animal to be surrendered to the Wild Rose Humane Society. You will be contacted by an intake volunteer about your request. Thank you for your patience.
Date *
MM
/
DD
/
YYYY
Name *
Your answer
Address and Town/City *
Your answer
Contact Information - email address and phone number *
Your answer
Type of Animal *
Breed
Your answer
Age
Your answer
Last vaccination *
Your answer
Reason For Surrender - please be specific *
Your answer
Submit
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