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| Rabbit Adoption Application | (Staff use) ID # ________________ ARK checked ____/____/________ |
| In order to be considered for an adoption you must: 1) be 21 years of age 2) have the knowledge and consent of all adults living in your household 3) have a valid ID with current address 4) understand that completing this application does not guarantee adoption and that the Humane Society of Central Illinois must approve your application. |
| Name ____________________________________________________________________________________ Date ____/____/________ |
| (Please print name(s) of all adults in the home) |
|
Address __________________________________________________________________________________________________________
City _____________________________________ County ______________________ State ________________ Zip Code ___________ Home Phone ______________________________ Work ______________________________ Cell ______________________________ If we may use e-mail to contact you, please include an address _______________________________________________________________ DO YOU: Attend School _____ Work _____ Employer __________________________ Spouse's employer ________________________ DO YOU LIVE IN A: House _____ Apartment _____ Condo _____ Dorm _____ Mobile Home _____ DO YOU: Rent _____ Own _____ Live with Parents _____ Landlord's Name ________________________________________________ Landlord's Address ___________________________________________________ Phone _________________________ How long at current address ______________ If less than 1 year please list previous address and how long there _______________________ ________________________________________________________________________________________________________________ Please provide the following information about your household: Number of Adults ________ Number of Children _______ Ages of children ______________________ Who will be primarily responsible for the care (feeding, grooming, exercise and training) of your new pet? ___________________________________________________________________________________________________ Why would you like to adopt a pet from us? Please check all that apply. Companion ______ Gift ______ To Breed ______ For a Child _____ Other ________________________________ How many pets do you have now: Dogs _______ Cats _______ How many pets have you had in the last 5 years _______ Please list any pets you now have or have had in the past. If more space is needed use additional sheet. |
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NAME |
TYPE/BREED |
AGE |
SEX |
FIXED? |
WHY YOU NO LONGER HAVE |
|
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Have you ever adopted an animal from a shelter? If yes, Where? _____________________________________ When? _______________ Are your current pets up to date on vaccinations and other necessary vet care? ___________________________________________________ What veterinarian would have records (past/present)? _______________________________________________________________________ Which veterinarian do you plan to use? _________________________________________________________________________________ How much do you anticipate spending yearly on food, vet care and other expenses for your pet? _____________________________________ Have you had a rabbit before? ______ Where is he/she now? ____________________________________ Do you have the proper cage and supplies? ______ Is your home and yard bunny-proofed? ______ Will you be able to supervise any children around this rabbit? ______ Do you have any animals that could endanger the rabbit? (Rabbits can die when frightened by a predator.) ____________________________ Where will you keep the rabbit? Inside ______ Outside ______ Do any members of your household have allergies? ______________ To what? ________________________________________________ Do you have any plans to move in the near future? _______ If at some time you do move, what will you do with your pet? ________________________________________________________________________________________________________________ What food will you use? __________________________________ How often will you groom/brush? _______________________________ A rabbit can live well over 10 years and requires a major commitment of time, finances and emotion. Why do you feel you can make that kind of commitment at this time? ______________________________________________________________________________________ |
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No rabbit will be adopted to anyone under the influence of drugs or alcohol, with a history of animal
abuse, animal loss or multiple animal violations, or to anyone living in a transient state.
By signing below, I certify that the information given is true and correct and I recognize that any misrepresentation of facts will result in my losing the privilege of adopting a pet. I also give my veterinarian permission to release any vet care records and information about my current and past pets to the Humane Society of Central Illinois. I understand that this application is the property of the Humane Society of Central Illinois and that the Humane Society of Central Illinois has the right to deny my request to adopt. |
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Signature ____________________________________________________ Date _____/_____/_________
Signature ____________________________________________________ Date _____/_____/_________ |
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