Polk County Humane Society Request to Surrender Form

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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. I understand that if I fail to tell the truth about the animal(s) that I wish to surrender, I  could  endanger the safety of a staff person or another pet at Polk County Humane Society.


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