Statement of Support from Licensed Veterinarian (D.V.M.)
In reference to: ____________________________________________
Applicant's Name
I am personally acquainted with the above named applicant for a State wildlife rehabilitation permit and am familiar with his/her intended activities related to wildlife rehabilitation.
I hereby agree to provide consultation and medical services for wildlife upon request of the applicant and subject to my professional judgment.
I understand that I am under no obligation to provide free services; nor am I to be held responsible for the actions, judgment, or conduct of this applicant. This statement does not imply an endorsement of this applicant.
Signature ___________________________ Date _________________
Print Name_______________________________
Applicant: Please submit this form with your exam and other supporting materials.
