Owner Surrender Form

Owner Surrender Form

Please fill out this form in its entirety as much as you can. We need as much information about your animal to ensure we give them the proper care they deserve.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Animal's Name*
Type of Animal Surrendered*
Sex (if known)*
Age (approximate is okay)*
Picture (if possible)*

Browse Files

Cancelof
Reason for surrendering*
Do you have an established Veterinarian?
Name of Vet Clinic he/she sees (if applicable).
Who's name will your animal be under at the Vet's office listed above? (if applicable)
Please list all past/present medical issues you are aware of (if any).*
What kind of enclosure/tank is your animal normally in?
What kind of lighting do you use? Example: UVB, Basking Light, Mercury Vapor Bulb, etc.
What kind of heat source do you use? Example: Basking Light, Heat Pad, Heat Rock, etc.
Do you use a thermostat to regulate the temperature?
Do you have any other animals in the home? If so, please list what they are below.*
How often does your animal eat?
Please describe your animal's diet and eating habit. Please be as detailed as possible.*
Our first priority is always our animals.

The Reptile House & Rescue is a federally registered 501(c)(3) nonprofit charitable organization. The Reptile House & Rescue is a 100% no-kill animal shelter and sanctuary with emphasis on all reptiles and amphibians.

Relinquishing Receipt for Animal surrendered to The Reptile House & Rescue by Owner

* I hereby give The Reptile House & Rescue permission to request all medical history and medical records from my Veterinarian for the animal I am relinquishing.

*I acknowledge that my signature/submission of the form and this receipt relinquishes all claims of ownership of the animal(s) described. Neither my family, any representatives acting on my behalf, nor I may assert present and/or future claims, suites, or otherwise against The Reptile House & Rescue with respect to this animal(s). I understand that The Reptile House & Rescue will not return this animal to me, once left in its care, under any circumstances, unless otherwise approved by The Reptile House & Resuce Executive Director.
Signature*

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