Reptile Rapsody
Reptile Rescue
Statement of Surrender


Reptile Rapsody Reptile Rescue
"Home of the White Iguana"
(909)656-2113
19510 Van Buren Blvd.,F-3/232
Riverside, Ca. 92508

STATEMENT OF SURRENDER

I__________________________________________________________________
Print full name

__________________________________________________________________
Address City State Zip

( ) am the owner ( ) am the custodian ( ) found this animal(s) which has been, to the best of my knowledge, abandoned.
I hereby donate the described animal(s) to Reptile Rapsodyıs Reptile Rescue (RRRR). I understand and agree that the animal(s) will become the sole property of (RRRR). I further understand that I hereby relinquish all rights to the animal(s) permanently and without further recourse. I further release (RRRR) from any claims, present or future, related to the disposition of such animal(s). I understand that the animalıs condition may require euthanization if it is determined to be in the best interest of the animal(s).

_____________________________________________________________
Signature Date

_____________________________________________________________
Witnessed for; Date

DESCRIPTION OF ANIMAL(S)- Complete a separate form for each species


Species________________________ Sex_____ Age_____ Color_________

Name_________________________ Unusual markings or scars_________________

Are any medical records available? Y / N If yes give Vets Name:________________________

Vets Telephone #_______________________________

Location of animal(s) found or acquired (bought, adopted, gift):_____________________________

How long has this animal been in captivity? _________________________________________

Has this animal ever bitten anyone? Y / N If yes, describe the circumstances on the back of this page.

What has this animal been fed?________________________________________

How much did it eat?________________________________________

Did it keep it's last meal down?__________________ Does it eat killed prey?________


GOVERNMENT AGENCY/SHELTER


Agency name________________________________________________________________

Address____________________________________________________________________

City, State, Zip ______________________________________________________________

Contact Name________________________________ Title____________________________

Phone #______________________

( ) See attached paperwork ( ) See above

FINAL DISPOSITION

Animal was ( )Released for adoption ( ) DOA ( ) Deceased ( )Euthanized ( ) Other

Date____________________



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