Intake Request

Complete this form to request HAVA to bring an animal into our care.

About You

First Name: Last Name:

Are you over 18?

Mobile phone number:

E-mail:

Mailing Address:

City: State: Zip Code:

Intake Request

Type/Species:

To the best of your knowledge, select the option that best fits the situation:

Why do you believe this animal is a stray or feral? (255 chars left)

Please provide a physical description of animal: (255 chars left)

How long have you been caring for this animal?

Please provide any additional information you wish to share with us: (32768 chars left)

Acknowledgement

I agree to the following:

I certify that the above information I have given is accurate and truthful and I authorize a HAVA member to verify any and all information in this request.
I certify that either I am the owner or to the best of my knowledge, no other person has any right to this animal.
I hereby surrender all rights to this animal.
I understand that once I relinquish the animal, the animal will not be available to be returned.

By submitting this form electronically you understand the the terms of this request.

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