First name: Last name:
Address: City: Zip Code:
Phone: Email: Cell:

Name to appear on Adoption Certificate and on animal's shelter:

1st choice of animal to adopt for $150: Select from pull down menu The Giant Millipede Family Mr. Turtleneck the Ball Python Boris the Russian Tortoise Rocky the Eastern Box Turtle Madagascar Hissing Cockroach Family 1000 honey bees Clementine the Eastern Painted Turtle Slip the Eastern Painted Turtle Slide the Eastern Painted Turtle Sal the Eastern Painted Turtle Red Wiggler Worm Bin II

2nd choice (in case first choice is not available): Select from pull down menu The Giant Millipede Family Mr. Turtleneck the Ball Python Boris the Russian Tortoise Rocky the Eastern Box Turtle Madagascar Hissing Cockroach Family 1000 honey bees Clementine the Eastern Painted Turtle Slip the Eastern Painted Turtle Slide the Eastern Painted Turtle Sal the Eastern Painted Turtle Red Wiggler Worm Bin II