First Name

Last Name

Street Address

City

State

Zip Code

Email

Home Phone

Cell Phone

Year Born

Which turtle are you interested in?

If undecided, do you have a species, sex, and/or age preference?

Why are you interested in adopting a turtle?

Do you currently keep any reptiles?
NoYes

If so, what species do you keep and have long have you been keeping them?

Have you read the turtle care sheet?
NoYes

Do you have an appropriate setup for your turtle?
NoYes

If so, please describe your setup in detail. Include lighting, heating, tank dimensions, basking area, and décor. Please email a picture of your setup to debbie@dancingturtlewildlife.com

If not, do you need assistance in obtaining a setup?
NoYes

Do you own or rent your home?
OwnRent

If you rent, have you received approval from your landlord to have an animal?
NoYes

Who in the household will care for the turtle?

Veterinarian’s Name:

Phone:

Does this veterinarian see reptiles?
NoYes

Have you ever surrendered a pet?
NoYes

If yes, please explain.

I certify that the information entered on this application is true. (Enter your name and date.)
Name

Date

Parental permission is required if the applicant is under 18 years of age.

Parent’s name:

Phone: