Name *

First Name

Last Name

Phone *

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Supplies check *

Please check all that you have or plan to purchase.

Litter box (triangular)

Litter box (cat sized)

Flea control

Hard plastic pet carrier

Soft sided pet carrier

Large food bowl

Large water bowl

Rabbit water bottle

Large x-pen

Large cage

Small cage

Responsibility reality check *

Please check all that apply

I am prepared to care for a rabbit for their entire life, as many as 12 years

All of my family members have willingly agreed to adopt a rabbit

I understand that between medical bills and supplies, a rabbit may cost more than $1500 a year, and I am able and happy to cover that cost for the well being of my new pet.

I have checked with my family members and they do not have an animal or hay allergy

I understand that many common plants such as garlic, onion, tomato leaves, potato leaves, milkweed, chrysanthemum, poinsettia, and daffodils are toxic to rabbits and it my responsibility to know and understand which plants are poisonous so that my new rabbit(s) will not have access to them.

I understand that bare electrical cords WILL get chewed on and can be fatal to rabbits, and I will cover or put them away.

I understand that I will not be able to use harsh floor cleaners (such as bleach or ammonia based) because it can kill my new pet.

I understand that essential oils are toxic to rabbits and may kill them.

Concerns (so that we know what to help you with) *

Check all that apply - these will not disqualify you for adoption.

In my home, the TV is frequently loud

My home will frequently have visitors, either other people or pets.

I smoke

I plan to travel from time to time

I plan to have a child in the future

The environment in my home can become very busy at times

There is ongoing construction, or planned construction at or by my home

Other(Please describe in questions or concerns box)

None of the above