Rabbit Adoption Application

Rabbit Adoption Application Rabbit Name________________

Humane Society of Jefferson County, Inc.

Application Procedure

We request the following information in an attempt to assist you with the selection of your companion animal. The animal’s welfare is our foremost consideration. This process is designed to help us determine if the placement is in the animal’s best interest and to assist you in finding an animal best suited to your lifestyle. H.S.J.C. reserves the right to refuse an adoption to anyone for any reason. No animal will be adopted to prospective owners who mislead or fail to provide accurate information on this application.

Please read the following information carefully.

Fill out the application completely. Identification is required to verify information.
We do not do same day adoptions.
Every effort will be made to review the application in a timely manner. HSJC staff will notify you when the process has been completed and inform you of our decision.
Once an application has been approved it will remain on file for 6 months.
All family members must meet the new companion animal before adoption to ensure compatibility.

Name: ____________________ Phone:____________________ Date:______________

Birth date: _______________Drivers license #____________________State issued_____

Address: _________________________________________________

City __________________________ State: _____ Zip: __________ County_____________

Email address: ___________________________________

How long have you lived at this address? ___________

If there is a specific rabbit you are interested in? What is the name of the pet? __________

Pre-approve (pet selection not yet made) Yes / No

Type of residence

Circle one: House Apartment Duplex Mobile Home Farm

Live with friend/relative Condo Other____________________

If you rent, lease or own a condo or trailer please provide the following information:

Landlord or Condo association: ________________________________________________

Daytime phone: ________________________ Evening phone: _______________________

Are you planning to move within the next 6 months? ________________________________

Veterinary Information(for owned and previously owned pets)

Clinic name: _____________________________________________________________

Phone: ________________________

If you do not currently have a veterinarian, you will be asked to obtain one before the adoption is finalized.

Please list the pets you currently own and pets you have owned in the past 5 years:

Species Name Age Neutered? Still own?

__________________________________________________________________________

Are the pets you now own current on vaccinations? Yes / No

Are vaccination records under name listed on application? Yes / No

If you no longer own the pet, what happened to it?

_________________________________________________________________________

Have you ever adopted from a shelter before? Yes / No When?___________________

What kind of pet? _________________________________________________________

Have you ever surrendered an animal to a shelter? Yes / No When?________________

Why?_____________________________________________________________________

What is your past experience with rabbits? Please circle.

First time owner Current rabbit owner Had a rabbit in the past

How will you correct behavior problems in your rabbit if they occur?

__________________________________________________________________________

How much $ do you plan to spend per year to care for your rabbit? _____________________

Approximately how many hours a day will your rabbit be without human companionship? ___

Are you a frequent traveler? Yes / No

Who will care for your rabbit while you are away? __________________________________

Where will you keep the rabbit during the day? ____________________________________

Where will you keep the rabbit during the night? __________________________________

Are you willing and able to assume the financial responsibilities of pet ownership? Yes / No

Are you prepared to commit to caring for your new rabbit for the next 10 years? Yes / No

If you must move from your current place of residence what will you do with your pet?

__________________________________________________________________________

Will you allow your rabbit adequate time to adjust to a new home? Yes / No

How long? ______________________________________________

Are you aware of routine veterinary care recommended for the health of your rabbit? Yes /No

Please tell us a little about your household

What is the activity level of your household? Please circle.

Quiet Active Moderate activity

# of Children and ages _______________________ Adults__________________

Who will be the primary caretaker?__________________________________________

This rabbit is being adopted as: Please circle all that apply.

House rabbit Outside rabbit Gift Companion For a Child

Companion for another rabbit Hutch Rabbit Breeding

Does anyone residing in the house have any known pet allergies? Yes / No

Do you understand that all adopted rabbits must be spayed/neutered? Yes / No

Do you plan to allow your rabbit outdoors unattended? Yes / No

Circle items you would like more information about.

Litter box training Rabbit/Rabbit Introductions Dog/Cat Introductions Rabbits and Children

Spaying/Neutering Training Methods Proper diet

How did you learn about our organization? Please circle.

Pets of the Week Friend/Relative Phone Book Veterinarian

Radio Special Event Other ______________________

Release:
By submitting this document, you are stating that all the information given herein is accurate and complete and that you are hereby giving your consent for The Humane Society of Jefferson County to verify any and all information contained herein. The completion of this form does not entitle you to any guarantees or rights. HSJC will not be held liable in any way, for any animal, or its actions, once the animal has been placed.

Signature: _________________________________ Date:__________________

Received: Staff Initials________________ Date/Time:____________________

Office Use Only

Veterinary check _________________ Landlord approval __________________

Home ownership verified____________________ Pets licensed________________

Approved_______ Denied________Pending__________

Adopter notified___________________

Notes:

Include all correspondence relating to adoption. Please date and initial.

__________________________________________________________________________