Name: ____________________________________________________________________ Date: __________________________

Address: _____________________________________________ City/State/Zip:_____________________________________

E-Mail Address: ______________________________________________ Phone:(      )______________________________

How did you hear about Rabbit Haven? ______________________________________________________________________

Please tell us why you would like to adopt a rabbit. ______________________________________________________

Have you adopted from Rabbit Haven before? _______ When? _____________ Who? _______________________________

Do you live in a house / apartment / trailer / other _________________________? Do you rent / lease / own ?

If you rent or lease, do you have permission to keep a rabbit? _________

How long have you lived at this address? __________________________________________________________________

Are you planning on moving soon? __________________________________________________________________________

What will you do with this rabbit if you move? ____________________________________________________________

Are you adopting this rabbit for yourself / children / gift / other ______________________________________?

Who will be the primary caretaker of this rabbit? _________________________________________________________

Is there any member of the household allergic to rabbits? ____________

Have you ever had a rabbit before? ___________ When? ______________________________________________________

Will this rabbit live with another rabbit? ____________ Is he/she neutered? ____________

Will this rabbit live with other house pets? ___________ Type? ____________________________________________

Where will this rabbit live during the day? _______________________________________________________________

Where will this rabbit sleep at night? ____________________________________________________________________

Are you willing to bunny proof your house or rabbit area? ____________

Rabbits require specialized veterinary care. Do you have the name of a qualified veterinarian? (Please list)

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                    Applicant’s signature                           Parent, if under 18 years

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