Other Animals in the Home

Applicant Information

Name of Primary Caregiver: / Age:
Name of others in home: / Age:
Name of others in home: / Age:
Name of others in home: / Age:
Name of others in home: / Age:
Name of others in home: / Age:
Home Phone Number: / Cell Phone Number:
Email Address:
Current address:
City: / State: / ZIP Code:
OwnRent(Please circle) / How long?
If Rent, please attach a copy of your lease/pet agreement or provide landlord information below:
Landlord Name: / Landlord Number:

Other Animals in the Home

Pet Type (circle appropriate species) / Breed: / Age: / Altered? / Still Own?
Dog / Cat / Rabbit / Guinea Pig / Other / Yes / No / Yes / No
Dog / Cat / Rabbit / Guinea Pig / Other / Yes / No / Yes / No
Dog / Cat / Rabbit / Guinea Pig / Other / Yes / No / Yes / No
Dog / Cat / Rabbit / Guinea Pig / Other / Yes / No / Yes / No
Dog / Cat / Rabbit / Guinea Pig / Other / Yes / No / Yes / No
Dog / Cat / Rabbit / Guinea Pig / Other / Yes / No / Yes / No

Veterinarian Information

Clinic Name

Animals Seen

Plan to use for critters?

Yes

Are you willing to take your small animal to the vet for a yearly well-pet exam?

Yes

Preferred Animal Information

Type of Animal You Wish to Adopt:

Rabbit

Guinea Pig

Chinchilla

Hamster

Other

Name of Animal(s) you are interested in:

Is there a specific breed you are looking for?

Pre

Preferred Sex:

Male

Female

Preferred Age:

Baby

Young

Adult

Senior

Would you be interested in a bonded pair?

Yes

Would you be willing to take in an animal with medical needs (medications, bandages, etc?)

Yes

Would you be willing to take in an untrained animal?

Yes

Are you able/willing to medicate your new pet if necessary?

Yes

In the box below please tell us about what you are looking for in your new pet (temperament, behavior, etc) so that we can help match you up with the best rabbit for your family!

Your Plans for Your New Addition!

Please describe the enclosure you are planning to use for your new pet:

Will your pet be allowed outdoors? How often?

Tell us about the diet you will be feeding to your new pet?

How much time do you think your new pet will take each day?

What amount of money are you willing to spend on day to day maintenance of your new pet?

How much would you be willing to spend in case of an emergency or illness?

If you can no longer care for your pet for personal or financial reasons, what would you do with it?

I attest that all information submitted in this application is true and accurate and should any of the above information be proved inaccurate I surrender all rights to any animal adopted under the false information. Applicants must be 18 years or older to apply.

Signature (typed is acceptable for application)Date