When I adopted Albert and Tofu they asked me: (I filled it out, to give you a general idea of what I answered)
Type of residence: ___-_ House ____ Apt. ____ Condo ____ Mobile Home ____ Military
Do you (check what applies) ? _____ Rent __-___ Own _____ Live with owner of home
Please list landlord or property management company and telephone number:
Please provide your previous address if you have lived at your current address for less than one year:
Previous Address:_____________________I'm not going to give out that info online.
Please list the Names and Ages of all of the people residing in your household:
If living with roommates or in part of someone else’s home, do you have the consent of all the adults living in
the household? _____ Yes _____ No
Does anyone in your household have ANY allergies to ANY animal(s)? __-___ Yes _____ No
If yes, please describe:_______________________Horses____________________________________________
What is your plan if someone in your house is allergic to this new pet?____We would move him/her to another room, and let someone else take over as caregiver_____________________
What will happen to this pet if you have to move unexpectedly? ______________Take him/her with us____________________
Who will be the primary caretaker of this small mammal?_____________________Me___________________
Why would you like to adopt this animal?
____________After my other pig died, I've bee longing for another (or 2!)____
Please list any and all animal(s) you’ve owned in the past 5 years, including the ones you own now:
Type/Breed Age Sex “Fixed?” Still Own?
Dog labrodoodle female fixed died of lymphoma last year
Dog labradoodle male fixed still own.
Dog coton de tulear female fixed still own
guinea pig female not fixed died last year_____________________________________________________________________________________
Who is your Veterinarian? ______-______________________ May we call him/her?_______yes__________
Please choose the option(s) that best describes where you will keep your pet. Circle all that apply:
Outdoor hutch Cage in garage or basement Cage or hutch in barn
Loose indoors with access to a litter box Cage in the house
Outdoor hutch with run Other:_________________________________________
Many small mammals and rabbits are surrendered to us by the parents of the children who lost interest in
them. Rabbits can live to be 7 years old or older. If adopting this animal as a child’s pet, what is your plan for
his/her future if the child loses interest?
_____________________________________I know my daughter will never lose interest. if she did, another family member would assume the role or caregiver____________________________________________________
Do you have any questions or concerns about adopting a rabbit or small mammal? Is there anything about
small animal care you would like to know more about?
By signing below, I hereby submit that the information provided by me is true. Any false information may
result in my losing the privilege of adopting a pet. I understand that the - has the right to deny my
request to adopt an animal, and that this application must be completed and approved, by the -, before
an animal adoption may be considered.
Signature: __________-__________________________________ Date: ______August 21 2013_________