Name:   Email Address:

Address:

City:      State:      Zip:

Home Phone: Work Phone:

If renting, do you have permission to have a rabbit?  [check only if yes]

Landlord Name and Phone No:

Describe where you are planning to house your rabbit?

Who will be the principal caregiver for the rabbit?

What pets do you currently own?

What pets in the previous 5 years?

List ages of children under 18 residing with you:

Is anyone in your household allergic to pets?  [check only if yes]

What would you do with this rabbit if you decide to move?

What would happen if your rabbit needed medical care?

Vet/Hospital currently treating your pets:

Have you owned a rabbit in the last ten years:   [check only if yes]

If yes, how long did you have it and what happened to it?

I UNDERSTAND THAT WHILE EVERY EFFORT IS MADE TO PROVIDE A HEALTHY PET, THESE ARE RESCUES AND NO GUARANTEE IS IMPLIED REGARDING FUTURE ILLNESSES.

I HAVE ANSWERED THE ABOVE QUESTIONS HONESTLY AND HAVE MADE NO MISREPRESENTATION.

I UNDERSTAND THAT MY APPLICATION MAY BE DECLINED FOR ANY REASON.

PetSave to Complete:
Adoption Fee Collected ... Single___________  Pair____________  Group____________