CVO Jotform
Client Name
*
First Name
Last Name
Client phone(s) *if applicable*
Your Information
Name
*
First Name
Last Name
What organization do you work with?
*
What location are you requesting a visit?
*
Kitchener Waterloo Humane Society
Stratford Perth Humane Society
Offsite Location
If offsite, what location are you requesting a visit?
Name of location
Street Address
City
State / Province
Postal / Zip Code
What is the best way to get in contact with you?
Phone Number
Please enter a valid phone number.
If by phone, would you prefer a call or a text?
Call
Text
Both
Email
example@example.com
Please give us a description of the services you require
*
Wellness Exam
Nail Trim
Vaccines
Spay/Neuter
Health Concern *describe below*
Please describe any concerns or options not listed above
If your request is urgent, please contact Becky, the Community Outreach Coordinator directly. Becky can be reached by phone, text or email at: 226-220-7885 or becky.ayre@kwsphumane.ca
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