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.
Email address *
Date *
MM
/
DD
/
YYYY
Name *
Address and Town/City *
Contact Information - email address and phone number *
Type of Animal *
Breed
Age
Last vaccination *
Reason For Surrender - please be specific *
Submit
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