Heartland Rabbit Rescue Adoption Questionnaire

Heartland Rabbit Rescue Adoption Questionnaire
Your full name:*
Street Address:*
City, State, Zip*
Phone number:*

Area CodePhone Number
Is texting ok?

YesNo
E-mail:
Have you adopted from us before?*

YesNo
If yes, explain:
I am looking for...*

Single BunnyAdopted Pair
I am interested in the bunny named:
This adoption is for*

MyselfMy childAs a gift
This bunny will live mostly*

InsideOutsideBoth

Please estimate the amount of time*

	0%	25%	50%	75%	100%
Inside
Outside
Garage
Other

How long will the bunny be alone each day?*
When alone, where will the bunny stay?*

Please list how many of each pet you have:*

	0	1	2	3	4+
Rabbits
Dogs
Cats
Birds
Reptiles
Other

Of your pets how many live inside?*
How many live outside?*
How many of your pets are spayed/neutered?*
Have you had pets in the past?*

YesNo
What became of them?*
Are you willing to pay for veterinary care if this rabbit becomes sick or injured?*

YesNo
Are you willing to ensure this bunny receives yearly veterinarian check-ups?*

YesNo
Would you object to a home visit by one of our volunteers?*

YesNo
Do you own or rent?*

OwnRent
How long have you lived here?*
Which of these do you own/rent?*

HouseMobile HomeCondoApartmentOther
Has your Landlord or Home Owners Association given permission for a rabbit to reside with you?*

YesPet deposit requiredNo
Name and Phone number of Landlord or HOA.
Are you planning to move in the next few years?*

YesNo
If yes, what will become of the bunny?*
How many adults Type a label* and children Type a label* live in your home? What are the ages of the children Type a label* ?
Who will be the bunny's primary care giver?*
How will this bunny be cared for when you or the primary care giver are out of town?*
Is anyone in your home allergic to animals?*

YesNo
What will you do if someone becomes allergic to this rabbit?*
Rabbits will eat plants and chew on just about everything. What precautions are you willing to take to protect this bunny and your home?*
Rabbits need daily exercise. When and where will this bunny be able to get its exercise?*
What kind of rabbit behavior do you feel that you CAN NOT tolerate?*
Under what circumstances would you NOT be able to keep this rabbit?*
Would you like a veterinarian referral?*

YesNo
Would you like info on caring for rabbits?*

YesNo
Would you be interested in volunteer work?*

YesNo
How did you hear about our organization?*
Any questions, comments, or additional information?
Should be Empty: