Rehoming Your Small Mammal / Exotic Animal - 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 animal?What is your animal's name?What species and breed is your animal?How old is your animal?How did you acquire your animal?How long have you owned?Who is your veterinarian?Has your animal been altered?Any known medical issues, dietary restrictions, or prescriptions?What type of housing does your animal use?Approximate square feet of housing?Bedding type:Is your animal on a specific diet?How does your animal consume water? (ex.: bottle, bowl, etc.)What are your animal's favorite foods?What are your animal's favorite activities?Describe your animal's personality:How is your animal with children?How often was your animal handled and how do they do with being handled?Have they lived with other animals of the same species? Other species?Does your animal have specific fears to note?Does your animal display any behaviors worth noting?Has your animal 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 animal 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 animal 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 animal 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 animal?Can we call you with follow up questions if needed?CAPTCHA
