Quarantine Authorization Form

PUBLIC ANIMAL WELFARE SERVICES

Location Animal(s) came from *
Sex
Species
Breed
Color *
Pet Name
Name and Address
First name *
Last name *
Address *
City *
State *
Zipcode *
Phone Number *
Email Address *
Driver's License No. *
Select Choose File and Take Picture of your Driver’s License *
*	I UNDERSTAND THAT MY ANIMAL MUST BE PICKED UP NO LATER THAN 10 DAYS FROM THE DATE OF THE BITE OR IT WILL BECOME THE PROPERTY OF PUBLIC ANIMAL WELFARE SERVICES AND COULD BE EUTHANIZED.
Signature

Name and Address