Wildlife in the Classroom Reporting Form

Teacher Name*

School System*

Name of School*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Enter Email Confirm Email

Species

How many species would you like to add to this form?*

If you need to add more than 5 species, you will need to submit additional forms.

Species #1

Common Name*

Scientific Name*

Number of Individuals*

Obtained From*

Date Range for the Species to be Displayed*

Educational Role of This Species*

Species #2

Common Name*

Scientific Name*

Number of Individuals*

Obtained From*

Date Range for the Species to be Displayed*

Educational Role of This Species*

Species #3

Common Name*

Scientific Name*

Number of Individuals*

Obtained From*

Date Range for the Species to be Displayed*

Educational Role of This Species*

Species #4

Common Name*

Scientific Name*

Number of Individuals*

Obtained From*

Date Range for the Species to be Displayed*

Educational Role of This Species*

Species #5

Common Name*

Scientific Name*

Number of Individuals*

Obtained From*

Date Range for the Species to be Displayed*

Educational Role of This Species*

I understand that…

Accept Condition 1*

any person bitten by (native/naturalized) mammalian wildlife must report the injury to the local health department. The offending animal must be segregated and housed separately from other animals and humans until the health department is notified.

Accept Condition 2*

wildlife must be confined under sanitary and humane conditions that are appropriate for the species in captivity. All cages and enclosures shall be locked at all times when wildlife is not under the immediate control or direct supervision of the teacher to prevent wildlife escape and unauthorized contact with individuals.

Accept Condition 3*

no wildlife held, possessed, or displayed may be released for any purpose without the written authorization of the department.

Accept Condition 4*

the department (DWR) shall be notified within 24 hours of an instance of wildlife sickness or disease or in the event of an escape.

Accept Condition 5*

teachers possessing and displaying wildlife for educational purposes in accordance with this section shall comply with all other school system, local, state, and federal laws and regulations pertaining to species possessed and displayed.

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