Rehoming Your Reptile - Weld Campus Owner Name First Last PhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What brings you to NOCO Humane to surrender your reptile?Animal name:Breed:Age:How did you acquire your reptile?How long have you owned?Who is your veterinarian?What housing does your reptile have? (ex.: 40 gallon tank, personal room in home, etc.)What lighting does your reptile need? (ex.: UV, heat lamp, night light, etc.)Is your reptile taking any supplements?Any known medical issues, dietary restrictions, or prescriptions?Does your animal require any special care? (ex.: only drinks water off plants, picky eating, etc.)Is your bird on a specific diet? And when/how often do they eat?When did your reptile last eat?Does your animal display any behaviors worth noting?Has your reptile bitten a person and broken the skin? Yes No If you answered Yes to the question above, please describe the situation and how it happened:Has your reptile displayed any of the following behaviors toward people? (Check all that apply) Growl Bark Lunge Hiss Swat Scratch Chase Urinate Snap Raise hair Tense Hard stare Fixate To the above question, who or what type of people have these behaviors occurred with? (ie. Children, men, women, strangers, veterinarians, owner, one person in particular, etc.)Has your reptile ever been in an altercation with another animal? If yes, please explain: Yes No If yes to the question above, were there injuries from this altercation?If applicable, did the injured animal require medical treatment? What degree of damage was done? (ie. stitches, amputation, etc.)If applicable, how did you stop the altercation and how easily was the altercation stopped?Has your reptile displayed any of the following behaviors toward another animal? (Check all that apply) Growl Bark Lunge Hiss Swat Scratch Chase Urinate Snap Raised hair Tense Hard stare Fixate Is there anything else you would like to share about your reptile?Can we call you with follow up questions if needed?CAPTCHA
