Surrender An Animal

Please fill out the form below and click submit

Animal information:

Species of Animal:       

Size:                                                                        

Name:            

Age:                                                                        

Current Cage Size:       

Sex:                                                                          

Where Obtained:                       

When Obtained:             

How Often Fed:                         

Last Fed:                                                 

Diet(explain in detail):

Medical Conditions:

Supplies Included:

Vet name:         
          
Vet Number:        

Name:                                      

Address:                                

Phone number:  

Email:
                                   
I hereby donate to the Pacific Northwest Herpetological Society (PNHS) the above mentioned animal, to be dealt with in the best intrest of the animal(including euthanasia, if medical conditions warrants) I relinquish all claims to the above mentioned animal and/or any of its progeny and acknowledge that the animal and/or all donated supplies and equipment are now property of pnhs upon submitting this form I also state that I am authorized to release this animal and all intrest in this animal and properties to the pnhs.