Sheltered Shells Tortoise Rescue
                                        Surrender Form


Owners First and last name: _________________________________________

Phone: ___________________________________________________________

Email: ____________________________________________________________

Tortoise name: ____________________________________________________

Species of tortoise: ________________________________________________

Gender:  Male ___       Female ___     Unknown ____

Age: (if known) ___________________________________________________

Health status: ____________________________________________________

Current diet: ______________________________________________________

__________________________________________________________________
 
Accessories donating: _______________________________________________

Level of Urgency: ___________________________________________________

Location: (City) ____________________________________________________

Additional information:___________________________________________

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