Polk County Humane Society
Phone: (417) 777-3647
Email: goingtothedogs1@windstream.net

Polk County Humane Society Request to Surrender Form


Fill out the form below. Please complete all sections of it.

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Your Personal Information

Additional Information

Description of Pet(s)

Pet's Health Information

Pet's Behavior Assessment

Signature

I certify that the information included in this surrender request form is accurate and true.

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