Rabbit Adoption Questionaire

The information you provide will help us help you find the rabbit who best fits with you and your family. Feel free to expand on any issue or ask any questions in the Comments section at the end. We welcome your feedback and suggestions!

PLEASE NOTE:

To be considered for adoption, this WHOLE form must be filled out. You must be 18 years or older to complete this application. If you are under 18, a parent or guardian must complete the application. Any applications that are not filled out properly will not be processed.

Date: *

Month Day Year

Full Name *

First Name Last Name

Are you over 18? *

Yes No

Home Phone *

Area Code Phone Number

Cell Phone *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail *

Please list family members and other people who live in your household, including roommates, students, etc.

First Name:

Age:

First Name:

Age:

First Name:

Age:

First Name:

Age:

First Name:

Age:

The primary caregiver will be:

Do all members of your household favor having a house rabbit?

Does any member of your household have allergies to animals or hay?

Please describe the level of household activity:

Housing (Check all that apply):

Own Rent Live with parents School Millitary

House Condo Apartment Mobile Home

If you rent, can you provide a copy of your lease agreement?

Landlord's Name:

Phone Number

Area Code Phone Number

Do you plan on moving in the next two years?

If so, do you plan on taking your pets?

Why did you select a house rabbit for a companion?

Have you had house rabbits before?

Do you have a rabbit now?

If you currently have a rabbit, are they vaccinated?

Yes No

Is it spayed or neutered?

If Yes, when were they fixed?

If yes, where and what does your rabbit live in?

Are you looking for:

Is there a specific rabbit in whom you are interested in?

Why are you interested in him or her?

How long have you been thinking about searching for a rabbit?

Please describe the level of research you have done to date on rabbits and rabbit care:

Education from (please check all that apply):

None Yet CCRR Breeder Friend with rabbit experience House Rabbit Handbook Other books on rabbit care

Preliminary internet research Extensive internet research Pet store Other rabbit rescues

Other:

How long do you expect to have your new rabbit?

YEARS

I must have:

Size (lbs):

Age:

Breed/Color:

Other:

a bunny I can hold a litter trained bunny a quiet bunny a bunny who will sit in my lap

an affectionate bunny an active bunny an easy-going bunny

I don't want:

Size (lbs):

Age:

Breed/Color:

Other:

a bunny I can't hold a messy bunny a shy or scared bunny a bunny who won't sit in my lap

a chewer a rambunctious bunny a digger a shedder

Please list all animals, including rabbits, currently in the household:

1. Type:

Age:

Sex:

Spayed/Neutered?

Kept:

How long has he/she been with you?

Where did you get him/her?

2. Type:

Age:

Sex:

Spay/Neutered?

Kept:

How long has he/she been with you?

Where did you get him/her?

3. Type

Age:

Sex:

Spayed/Neutered?

Kept:

How long has he/she been with you?

Where did you get him/her?

Do you have any other animals not listed above:

Please describe the animals, including rabbits, no longer in your household:

1. Type:

Age:

Sex:

Spayed/Neutered?

Kept:

How long was he/she with you?

Where did you get him/her?

What happened to him/her?

2. Type:

Age:

Sex:

Spayed/Neutered?

Kept:

How long was he/she with you?

Where did you get him/her?

What happened to him/her?

3. Type:

Age:

Sex:

Spayed/Neutered?

Kept:

How long was he/she with you?

Where did you get him/her?

What happened to him/her?

Have you personally ever given away any of your pets?

If so, please describe the circumstances:

Please describe the diet you would give your future rabbit (or current rabbit(s), including amounts and frequency of feedings.

What type of litter do you/will you use?

How often do/will you change the literbox?

Please describe your new bunny's living conditions:

Living Space:

Please give the dimensions of your cage or area

Location of living space:

Amount of play time per day

HOURS

Amount of time with people per day:

HOURS

Do you currently have a veterinarian?

If yes, who and where are they located?

Do you know where to go in a medical emergency if your vet is closed?

How much money per month are you willing to budget to care for your rabbit?

$

Are you willing to take your rabbit to a vet for an annual checkup?

How much money are you willing to spend in a medical emergency for your rabbit?

$

When you leave home on vacations or business trips, how will you provide for your rabbit?

If you lose the rabbit, what will you do to find him or her?

What will you do if you can no longer care for your rabbit, such as if you lose your job or become sick?

What will you do in the event of a lifestyle change, such as a incurring a new family member; working more hours; getting a new pet; starting a new hobby; traveling more; or moving?

Your comments or questions:

I hereby certify that all the information on this application is true, and I understand that false informatoin may void this application and any future applications. I also understand that failure to comply with future requirements, such as spaying or neutering, could result in my inability to adopt more animals from this organization.

Full Name

First Name Last Name

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Month Day Year

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Rabbit Adoption Questionaire

Your Household

Hopes and Expectations

Pet History

On-going Care: