This form must be used to request permanent possession of all non-releasable wildlife for education or foster animal purposes. This application is available to LICENSED WASHINGTON WILDLIFE REHABILITATORS ONLY. All others requesting wildlife collection and possession must use the Scientific Collections Permit Application at http://wdfw.wa.gov/licensing/scp/.
· All non-releasable education and foster animals must be included on your Wildlife Rehabilitation Annual Report Form which must be received by us by January 31 of every year.
· Your veterinarian must sign this application certifying non-releasability.
· PLEASE INCLUDE PHOTOGRAPHS of the Education or Foster animal(s) enclosure.
· You may apply for more than one animal with this form.
1. This animal(s) is to be used for
Education Foster
2. Type of animal(s) to be retained:
Mammal Migratory Bird – you must have a USFWS Live Possession permit
Non-Migratory Bird (check USFWS website if you are unsure of species on the Migratory Bird list)
Reptile/Amphibian
3. Special category animal: Please indicate a special species you are requesting:
Raptor Large Carnivore* Bat
State and/or Federal Threatened or Endangered Species
*Brown bear, black bear, cougar, wolf, bobcat, and lynx
Name of Applicant: / Phone #: / Email:Name of Facility:
Facility Address: / City: / Zip Code:
Facility Mailing Address: / City: / Zip Code:
WDFW Wildlife Rehabilitation Permit #:
Species Requested
Please indicate either Education (E) or
Foster (F) / Initial Illness or Injury / Reason for Non-releasability / Admission date
If this is a TRANSFER from another facility please complete the following information:
Name of party transferring the animal: / Phone #: / Email:Name of Facility or Organization:
Facility Address: / City: / Zip Code:
Facility Mailing Address: / City: / Zip Code:
State:
Reason for Transfer
I, (please print name) ______hereby agree to all of the conditions outlined in
WAC 232-12-841, WAC 232-12-843, and WAC 232-12-861 and the following:
WAC 232-12-275 Definitions – Oiled-wildlife and wildlife rehabilitation permits Section (29) "Wildlife rehabilitation" means the care and treatment of injured, diseased, oiled, or abandoned wildlife, including, but not limited to, capturing, transporting, treating, feeding, housing, and conditioning animals so they can be released back to the wild.
2011 Guidelines of the American Society of Mammologists for the Use of Wild Mammals in Research. (This applies to animals in captivity who may be experiencing pain, discomfort, and stress)
“The general principles for identifying captive mammals in pain or distress are abnormal appearance or behavior. Normal appearances and behavior are determined by species-specific characteristics and personal experience of the handlers. Because behavioral changes are the means to identify pain or distress, all personnel involved with animals should understand the normal behavioral patterns of the species they are housing. Thus, all animals should be monitored regularly by trained staff.
A source of pain generally is easy to identify if it is a physical abnormality, but stress or distress might not be due to pain and is not immediately recognizable. IACUCs (institutional animal care and use committees) generally consider that procedures that cause pain or distress in humans likely also will cause pain or distress in other animals. Characteristics of an animal in pain include, but are not limited to diarrhea or vomiting, poor coat, inflammation or bleeding, hair loss, abnormal posture, incessant scratching, self-aggression, lameness, whining, weight loss (20–25% of baseline), decreased food or water consumption (dehydration), decreased activity, or changes in body temperature, pulse, or respiratory rate (NRC 1992). Behaviors that might signal pain or distress include listlessness or lethargy, lying on the side for extended periods, inability to reach food or water, or unusual or prolonged vocalizations (NRC 1992).”
Distress is also indicated if the animal remains agitated, cowers, or hides for periods of time.
Common signs of stress in birds:
Erect posture
Feathers flat against the body
Recoiled or defensive posture
Agitation
Aggression
Freezing or immobility
Rapid fleeing or sudden takeoffs
Alarm calls or other frantic sounds
Nervous preening or twitching movements
Birds and mammals can experience stress if unable to perform normal functions, such as fly to a high perch, or climb when this is a normal behavior.
Your signature below certifies that you have read the above referenced WACs and above statements published by the American Society of Mammologist, 2011 Guidelines of the American Society of Mammologists for the Use of Wild Mammals in Research (captivity) and the list of Common signs of stress in birds.
Signature of Applicant Date of Application
An Annual Report must be submitted before January 31 of every year. Under RCW 77.15.750, a violation of the terms or conditions of the permit or any WDFW rule applicable to the issuance or use of the permit is a misdemeanor.
If any of your captive animals experience chronic pain, suffering, distress, or stress due to handling and captivity, they must be humanely euthanized.
Veterinarian’s certification
I certify that all animals listed on this form are non-releaseable to the wild. I also certify to the best of my ability that the condition or injuries experienced by this animal do not typically cause suffering with chronic pain.
______
Signature of Veterinarian certifying non-releasability Date
Please send the application to:
Patricia Thompson
Wildlife Rehabilitation Manager
Washington Dept of Fish and Wildlife
16018 Mill Creek Blvd.
Mill Creek, WA 98012
3 of 3 Revised 12/2016