Reptile Surrender Intake Form

Reptile Surrender Intake Form

Thank you for bringing your animal to Astray Center. We will evaluate your animal for possible placement. Every effort will be made to place your animal in a good home. The animal may be humanely euthanized if health problems are too severe. By placing your animal with us you will forfeit all rights, title and interest in the animal to Astray Center. We cannot answer inquiries as to the disposition or whereabouts of the animal after adopted. We as a small adoption fee to cover health costs associated with surrendered animals. Please fill out this form to surrender your reptile. Providing detailed information helps us give the best care for your pet.
Full Name of Surrendering Person

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Full Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Pets name

First NameLast Name
Species of Reptile
Specify Other Species
Gender
Age of Reptile (in years)
Health Status
Special Care Requirements or Notes
Medical History of Reptile
How many years have you had this animal?
Reason for surrendering
Behavioral Notes
What is it currently eating and how often? Please provide supplements and frequency.
Size and type of enclosure. Please add substrate information (what was on enclosure floor?)
Was UVB lighting provided?
As owner, or as custodian acting in good faith, I irrevocably give the following animal(s) to Astray Center.
Signature
Should be Empty: