Abgabetier Aufnahmeantrag (PDF)




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Reptilienvon ReptilienFranken
Auffangstatio Auffangstation
e.V.
Datum: 2015.05.28
n Franken e.V. 15:44:33 +02'00'

REPTILIEN-AUFFANGSTATION FRANKEN E.V.
HOTLINE:

E-Mail-Kontakt:

0162-5465134 (17.00-21.00 Uhr werktags)

reptilien-auffangstation@gmx.de

TIERVERMITTLUNG
Persönliche Angaben (Pflichtangaben):
Name, Vorname

________________________________________________________

Straße, Nr.

________________________________________________________

PLZ, Wohnort

________________________________________________________

Bundesland, Land

________________________________________________________

E-Mail-Adresse

________________________________________________________

Telefon/Handy

________________________________________________________

Geburtsdatum

________________________________________________________

Angaben zum Abgabetier:
Art

________________________________________________________

Gattung

________________________________________________________

Geschlecht (wenn bekannt)

________________________________________________________

Gifttier
Bekannte Krankheiten
Vergesellschaftung

ja

nein

________________________________________________________
ja

nein

Fütterungs-Intervall

________________________________________________________

Futter/Futtertiergröße

________________________________________________________

Ort, Datum, Unterschrift Halter

Ort, Datum, Unterschrift Auffangstation

_____________________________________

_____________________________________






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