Reptile Adoption ApplicationReptile Adoption ApplicationContact InformationFirst Name Last Name AddressAddress Line 1 Address Line 2 City State Zip Code Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePhone/Mobile Email Household InformationDo you Own RentIf renting, any pet restrictions? If renting, landlord contact information What type of home do you live in? - Select -HouseCondo/ApartmentParent's HomeHow many people in your household? Ages of children under 18, if any? Do children regularly visit your home? Are you over 18? - Select -YesNoOccupation? Do your pets get regular vet check-ups? Current Pets TYPE AND BREED OF PET AGE GENDER ALTERED? (If not, why?) Kept inside, outside or both? How long lived with you? Previous Pets TYPE AND BREED OF PET How long lived with you? Reason no longer living with you? My Home EnvironmentWhat size cage will your pet have? Who will be the primary care taker? What type of substrate will you use? Do you understand their nutrition, heat and humidity requirements? How much time on average will you dedicate to care of your animal a day? If I move, my plan for my pet is: Why do you want a reptile? My enrichment plan for my reptile My training plan for my reptile: It’s most important to me that my reptile What would cause you to give up a reptile What is your plan if the reptile needed unexpected vet care Do you agree to not breed your reptile - Select -YesNo Do you agree to surrender your reptile back to MMHRS in the event you no longer can care for them, or provide them with new owner contact and opportunity to approve new owner?ReferencesCurrent Veterinarian Or planned local exotic Vet First Name Last Name Phone/Mobile 1st Non-relative referenceFirst Name Last Name Phone/Mobile Relationship and How long known 2nd Non-relative referenceFirst Name Last Name Phone/Mobile Relationship and How long known I consent to having this website store my submitted information so they can respond to my inquiry I have read and understand the above application and have filled out this form honestly to the best of my ability and certify the above true and am in agreement with the above**Please attach pictures of their environment and enclosure.** Image Upload Choose File Image Upload Choose File Submit Form
