Surrender Form

Animal Surrender Form for SerpentHeart Rescue

Please fill out this form to surrender your reptile or exotic animal to SerpentHeart Rescue. Your information helps us provide the best care for your animal.
Owner Information
Owner's Full Name
Owner's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Email Address
example@example.com
Owner's Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you currently on social assistance?
If yes, provide proof of social assistance

Upload a document to apply for a fee waiver
Cancelof

Animal Details
Animal Species (e.g., snake, lizard, turtle)
Common Name or Morph
Animal Age
Years or Months?
Sex
Colour / Pattern / Morph Description
Size (Length & Weight if known)
Current Diet
Type of food, feeding schedule, and how they eat (Frozen/Thawed, Live Prey, Insects, Pellets, etc.)
Eating Habits:
Medical History (Any Known illnesses or conditions?)
If yes, Provide vet details and treatments
Behaviour Notes:
Temperament, handling tolerance, any known aggression or quirks.
Length of Ownership
Months/Years
Type of Enclosure Used
Glass terrarium, plastic tub, aquarium, custom built, etc.
Heating & lighting setup
Heat mats, ceramic heat emitters, UVB lighting, etc.
Humidity and Temperature Maintenance
Reason for Surrender
If other, Explain

Surrender Fee & Agreement

Surrender fee is $50.00 PER animal that we take in. Each animal MUST come with the enclosure they are currently in.
Request Fee Waiver due to Social Assistance?
Payment Method

Animal Surrender Form for SerpentHeart Rescue