Rabbit/small mammal pre adoption form

PLEASE NOTE--ALL FIELDS WITH A RED DOT ARE REQUIRED TO BE FILLED IN. If the question does not apply simply put NA or NONE.

Please fill out the pre-adoption application in it’s entirety. Incomplete applications will not be considered. Once you’ve submitted the application we will review it and will contact you if you’ve been approved. When your application is approved we will set up a time that you can come and meet the pet you are interested in or find one that is a good fit for you and your family. At that time you will be required to sign an adoption contract before taking your pet home.
There is a non-refundable adoption fee, $75 per rabbit; $50 per guinea pig. This fee will help defray the costs of food, supplies and medical needs of our foster pets. A discount will be given for pairs adopted.

Date*

Date

Name*

First NameLast Name

Are you 18 years of age or older? Please note that we will not adopt a pet to a minor without permission of parent or guardian **

Under 1818 or older

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

SECONDARY phone number

Area CodePhone Number

Email

example@example.com

How long have you lived at this address?*

Is there a particular pet that you are interested in or description of what you are wanting to adopt?*

Do you:*

RentOwnLive with parents

Have you owned rabbits/guinea pig in the past? **

YesNo

If you rent, does your landlord/HOA allow pets?*

YesNoNo, but everyone has pets

Landlord/HOA Name and phone number:*

Do you give us permission to contact your landlord/HOA?*

YesNo

If you have other animals in your household, please indicate what kind and how many. Please list type, sex and age. Or none *

What is your experience level with rabbits/Guinea Pig?*

	1	2	3	4	5

1 is None, 5 is Experienced

If there are other rabbits or guinea pigs in your home what are their name, age, sex, spayed or neutered and temperament?*

Have you ever surrendered an animal to a shelter?*

YesNo

If yes, please explain circumstances:*

Name, address and phone number of your current veterinarian:

How much do you anticipate your pet will cost in feed, materials and veterinarian care?*

How many adults live in your house? How many children and their ages?*

Who will be the primary caregiver of your rabbit/guinea pig?*

Does anyone in your household have allergies to animals or hay?*

YesNoUnsure

Where will your rabbit/guinea pig live? Please describe the enclosure, cage or set up you will be using. We may ask you for a picture. *

How many hours a day will your rabbit/guinea pig be allowed to safely roam free outside of their enclosure?*

Who will care for your rabbit/guinea pig on vacation or emergency situations where they have to be left? *

Describe the diet that will be provided for your rabbit/guinea pig:*

Is your home rabbit/guinea pig-proof? Are electrical wires covered or out of reach, are there any toxic plants or chemicals that can harm a rabbit?*

YesNoNot yet

What would happen to your rabbit/guinea pig if you moved, experienced a change in income or a shift in family dynamic?*

Are you financially able to provide emergency veterinarian services for your rabbit?*

Would you have any objections to a home visit prior to adoption with proper notice?*

NoYes

Please provide 3 references, not related to you or living with you. Name, telephone number and your relationship to them.*

I certify that the information given by me in this application is true and complete. I further understand that falsified information that I give will terminate action of the adoption process. I hereby authorize release disclosure of records and or other information concerning all of the above inquiries, including but not limited to tenancy information and veterinary records. IF SUBMITTING ELECTRONICALLY I MAKE THE ABOVE CERTIFICATION AS IF SIGNED PERSONALLY. I CERTIFY THAT I AM AT LEAST 18 YEARS OF AGE.

Signature*

Brody’s Cavy Rescue

Pre-Adoption application