Animal Information -
Animal Name:
Animal Species
Basic Information -
Name:
Address:
City:
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Date of Birth	You MUST be over 18 to apply.
Phone:
Email:
How did you hear about us?	PetSmart Store PetFinder Web Search Longmont Humane Society Humane Society of Boulder Valley Humane Society of Pikes Peak Region Other, Please Describe
Do you need a permit to keep a reptile in your county or state? Yes No     Your arrangments, do you live in a: House Condo/Townhouse Apartment Other, Explain     Who do you live with? Alone, Single Roomate/Significant Other Family     How long have you lived at your present address? If you rent, will you be notifing your landlord of the animal? Please provide Landlord Information   Name: Phone:     Are you planning on moving in the next 6 months?   Yes No If so, what do you plan to do with your animal?     Have you adopted an animal before? Yes No If so, what is the current status of that animal?     If you had to give up the animal you wish to adopt, what would you plan to do? (besides returning the animal to the shelter)   Have you ever brought any animals to the shelter or rescue society? If yes, please explain the circumstances   Have you had any other pets? If yes, please explain how long you had them, and why you no longer have them   Do you have any current pets? Please provide a list of them   Do you have a veterinarian who is experienced in evaluating and treating reptiles and amphibians? If Yes, please provide the name and phone number, if not,please view our list of recommeded herp vets (in Colorado):   If your animal got lost, describe how would you go about finding it?   How much money do you anticipate spending monthly to provide the appropiate food, medical care, permits (if applicable), and supplies?   Which member(s) of your household will be primarily responsable for feeding, cleaning, handling (if appropiate) and other general care of this animal?   Many reptiles live longer than 15 years; some tortoises may live more than 100 years. Are you ready to take responsibility for the animal you adopt for its entire life? How will you do this? What if you go on vacation?   Please describe the feeding regimen and habitat you have prepared (or are planning to prepare) for the animal you wish to adopt. If you would like information about what we recommend for any of these aspects of care, please refer to our housing and care guides! Food Feeding Frequency Habitat Size Construction Materials Substrate Heating system Lighting system Humidity system Ventilation Furnishings Water   How will the enclosure be secured to prevent escape? What qualities are you looking for in the animal you wish to adopt? (ex: Easy to handle, No handling, Complete Tail, etc etc...)   Any Comments or questions? Please supply them here
* I have read and understand the habitat requirements of the animal for which I'm applying.
* I understand that the $10 application fee is non-refundable and will be applied to the adoption fee when I am approved to adopt.