Reptile/Amphibian Surrender Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

What type of animal?

Approximate Age of Animal?

Does it have a name?

Why are you Surrendering the animal? Please know, we are a judgment free environment. This information is useful in understanding the animal's needs.

Does the animal have any specific medical conditions or physical limitations that we need to know to best care for it? If yes, please list them

Who is your family Veterinarian?

Please Upload a photo of the Animal if possible.

Signature

Is there any additional information you can provide us with that would help us give the animal the best care possible? Current diet? Current size enclosure? Has it been socialized around people/young children?

Upon reviewing this form, a staff member will contact you regarding the intake. We do our best to help as many people and animals as we can, following state licensing and regulations. While we can't guarantee the intake of all surrenders, we will certainly do our best to assist you however we are able. Our primary mission is always the safety and wellbeing of our animals.

Signature

By signing and submitting this form, you are recognizing that you filled in correct information to the best of your knowledge and ability on behalf of the animal you are surrendering. Proper information helps us do our best to understand the animal's current situation and needs, allowing us to properly care for it.

Also, you are acknowledging that the animal may or may not be a permanent resident of the Wildlive & Discovery Center of WV. Many times, when animals are healthy, they are carefully matched to new forever homes. Our adoption programs are very successful and have helped many animamls get rehomed out of the facility to carefully matched families.

Lastly, signing this form indicates you are agreeing that any information, such as existing mites or illness, has been properly disclosed in the notes section above. This is critical so that we can protect the health of our other animals.