Name
of rabbit you are interested
in (if applicable): |
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| Your
name |
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| Address
(incl city&zip): |
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| Telephone: |
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| Email
address (PLEASE BE ACCURATE, this is how
we will contact you): |
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| Where do you
live? |
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| Do you (select
all that apply) |
Own
Rent living w/roomates
Rent living alone
Living with Parents
Student
Other
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| List
all human members of household and ages of children |
|
| Does any member
of your household have any known allergies to animals? |
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| If yes, please
describe: |
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| Do you
have any future plans that may affect your ability to keep your
rabbit(s)? |
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| If yes, please describe: |
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| Do we have
permission to visit your home? |
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| If no, reason?: |
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| |
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| Do you have a rabbit now? |
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| Please describe your rabbit's diet |
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| Please describe your rabbit's housing |
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| Do you currently
have any pets? |
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| If yes,
please describe (include all animals includinghousemates' animals),
type, age, sex, spayed/neutered? where kept? Had how long? |
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| Are you willing to provide medical care for your pet? |
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| Your veterinarian's
name and Tel. number: |
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| Have you had pets in the past? |
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| List pets owned
in the past 10 years, other than those listed above. Include type, name,
age, sex, where you got him/her, when you stopped
owning the animals and reason |
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| Have you ever
brought an animal to the shelter? |
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| If yes, what
were the circumstances? |
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| Do you anticipate
moving soon? |
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| If yes, when? |
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| Which member
of your household will be primary caregiver for the rabbit? |
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| Please state
reason for wanting a rabbit as a companion: |
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| Please
describe where you intend to keep the pet and the type/size of
cage you will use (if applicable) |
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| Describe
the ways you plan to allow your rabbit to exercise, number of hours,
space, etc. |
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| How
did you find out about the House Rabbit society? |
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| Please click submit when you are done: |
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