Wildlife Intake Form Intake Form** STOP ** This is not a request form If you do not have an agreement (and a drop-off address) from an A.E.R.O. rehabilitator to accept your animal, do not fill out this form!! **PLEASE READ** A.E.R.O is dedicated to saving sick, injured or orphaned wildlife. If you have a severely injured animal or one which has been in a pet's mouth, please call a vet or find one through the Wildlife Rescue League (WRL) at 703-440-0800. If you have a healthy animal which you want to relocate, please contact Virginia Wildlife Removal (Mike Arrington) at 540-412-5757Drop-off DateBrought-in ByPhone NumberEmailDo you want to be added to our mailing list? Yes NoIf you'd like to be tagged in our social media posts please leave your social media tags here. (Although we do try to give updates as much as possible there is no guarantee that your animal will be on there).AddressAddress Line 1Address Line 2CityStateZip CodeHow did you hear about us? I've brought you wildlife before I found you via social media/internet Referred by someoneBy whom- Select -A friend or neighborWildlife Rescue League directly gave me your nameWildlife Rescue League sent me to the Dept Wildlife Resources directory of rehabilitatorsVeterinarianAnimal ControlTrapperAnother RehabilitatorOtherwhich media- Select -A.E.R.O. website/googleFacebookNextdoorVA Dept. of Wildlife ResourcesOtherPlease provide their name (If Animal Control, provide county)Other InfoPlease note that we do not work with, nor are financially supported by the Wildlife Rescue League. If you wish to donate to the rehabilitators directly caring for your animal(s), please do so through our A.E.R.O. website.Accepting Rehabber's Name or CitySpecies- Select -BatBeaverBirdChipmunkCottontail (Bunny)FawnFlying SquirrelFoxFrogGroundhogMouseOpossumRaccoonSkunkSnakeSquirrelTurtleOtherText InputNOTICE: Virginia defines a as a Rabies-Vectored species. Please answer the following questions with as much detail as possible.Did the the animal bite, scratch or lick anyone? Yes NoPlease describe what happenedList name, address, and phone number of person(s) bitten, scratched or lickedWas the animal hand-fed? Yes NoHas anyone handled the animal without gloves? Yes NoList name, address, and phone number of person(s) who handled without glovesDid the animal have any contact with a dog or a cat? Yes NoPlease describe the interactionIs the dog or cat referred above current on rabies vaccination? Yes NoNumber of YoungNumber of AdultsWhere was it foundCircumstancesCondition (describe)Date First SeenDate CapturedDid you feed the animal? Yes NoWhat/how/when did you feed the animal?Did you help it in any other way?All wildlife care is on a volunteer basis. If you care to leave a donation to help cover our expenses, it would be appreciated, and 100% will be used to care for your (s).By submitting this form, you agree to relinquish all claim to, and responsibility for, the above described animal upon delivery to an A.E.R.O representative.Submit Form
