Surrender Information:
First Name:
Last Name (Surname):
Address: (Street, City, State & Postal Code)
Phone:
E-mail:
Are you a contributing member of NEARR?: Choose OneYesNo
Herp's Name:
Herp Species:
Herp Age:
Herp Sex:
Herp Color or Morph:
Herp Markings or Scars:
What is the temperament of the Herp in question? Choose OneCalm & TameNeutral DemeanorAggressive or Bites
What equipment (enclosure, lighting, heating, dishes, etc) can you donate with it?:
Reason for Surrender:
Other Comments
If you wish to contact us offline and a reply is required; please send a self-addressed stamped envelope, along with your letter, to: NEARR c/o Richard Sisco 280 Browns Corner Road Canaan, ME 04924