Nature Nurses Wildlife Intake Form

1
Thank you for helping us save Ohio's Wildlife.

We rely solely on donations from the public, our Nature's Hero's: for the care, food and housing of all animals in our facilities.

We are not funded by the Ohio Division of Wildlife.

Our services that we provide are volunteer services only.

Monetary support helps us provide formula, supplies, caging, etc, to our Nurses.

If you are unable to support us monitarily, please ask us on other ways you can help us.

A donation is not required for us to take the animal, however, even small donations help.

We are a non-profit organization.

Your donations are TAX DEDUCTABLE!

WE ACCEPT CASH/CHECK/PAYPAL

Any and all donations are greatly appreciated!

Thank you from all the Nature Nurse's
2
Donation Amount - WILL PROCESS WITH PAYPALThis is only suggested amounts and not required to take the animal into our care.
prevnext( X )
40.00
USD
60.00
USD
80.00
USD
100.00
USD
Description
USD
+ OR enter a custom value
3
Please provide your NAME* This field is required.
First Name
Last Name
4
Your Address* This field is required.Please Provide Your Mailing Address
Street Address
Street Address 2
City
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Phone Number* This field is required.
Area Code
Phone Number
6
Email
example@example.com
7
How did you find Nature Nurses Wildlife Rescue?
8
Who is your Nature Nurse?This is the name of the Wildlife Rehabilitator who is taking this animal.
Savannah L.
Amy S.
Alicia M.
9
Animal Species* This field is required.What type Of animal
Rabbit
Squirrel
Opossum
Raccoon
Mouse
Skunk
Ground Hog
Bat
Fox
Chipmunk
Other: weasels/minks/misc.
Select One
10
QuantityHow many animals?
11
Where was this animal found* This field is required.Township and County Required
Street Address
Township/County
City
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
12
Date animal was foundPlease tell us when you found the animal
Date
Year
Month
Day
13
Reason Why Animal needs RehabilitatedWhy the animal is being brought in for rehab
Found on ground
In a trap
Fell from nest
Nest destroyed
In the road
Unable to stand
Limping
Oiled
Caught by cat
Caught by dog
Hit window
Hit by car, lawn mower, or weed eater
Shot
Abnormal behavior/appears sick
Caught in fishing line/hook
Orphaned (Mother known dead)
Orphaned (Suspected)
Other
14
Does the animal have visible injuries?
Caught by a Cat
Caught by a Dog
Has visible injuries
Has visible parasites (Fleas, Mites, Ticks, Magots)
Hit by Car
Has Open wound/blood showing
15
Did you give the animal anything to eat or drink? If so, please list below and be specific.AS A REMINDER DO NOT FEED IF POSSIBLE, BUT IF YOU HAVE, PLEASE LET US KNOW WHAT AND HOW MUCH
16
Photo of the animalIf you have taken a photo of the animal please include it
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
17
SIGNATURE OF RELEASE TO A PERMITTED WILDLIFE REHABILITATOR* This field is required.Note: This animal(s) are being released unconditionally to a Nature Nurses Wildlife Rescue rehabilitator (or organization volunteer) for rehabilitation and release. If wild animals are not returned to the original location, the release site will no be disclosed. Unless otherwise indicated, Nature Nurses Wildlife Rescue may send information about our organization and final disposition of the animal(s) being left in our care. By signing below, the finder is agreeing that the information provided is accurate to the best of his/her knowledge.
Clear
18
Nuisance Animal Law - PLEASE ACKNOWLEDGE* This field is required.Your initials will confirm that the animal(s) ARE NOT orphaned due to killing, trapping or relocating the mother because of a nuisance situation. According to the Ohio Dept of Natural Resources, Division of Wildlife, Minimum Standards for Wildlife Reb, Publication 547.5 page 11, laws prohibit us from taking an orphaned infant due to purposeful action of the homeowner. This animal(s) was orphaned from a natural event.
Clear
Should be Empty: