Small Animal Adoption Form

Guinea Pig/Rabbit/Hedgehog Adoption Form

All fields are required.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Daytime Phone(Required)

What type of animal?(Required)

What type of animal are you interested in adopting?

Own or Rent(Required)

Do you own or rent?

Own

Rent

Landlord Info(Required)

If you rent, provide landlord's contact info, including phone number and/or email address.

Do you have pets in your home now?(Required)

Do you have pets in your home now?

Yes

Does anyone in your family have pet allergies?(Required)

Does anyone in your family have pet allergies?

Yes

Pets in Home(Required)

If you currently have pets, what type and how many?

Adults in Home(Required)

Please list the names of all adults living in the household.

Children in Home(Required)

If children are in the home, please list how many and ages of each child.

Where will you keep this rabbit/hedgehog/guinea pig?(Required)

Where will you keep this rabbit/hedgehog/guinea pig?

Inside

Outside

Both

If you indicated both, please explain.(Required)

If you indicated both, please explain.

How long each day are you away from home?(Required)

How long each day are you away from home?

How will you contain this rabbit/hedgehog/guinea pig?(Required)

How will you contain this rabbit/hedgehog/guinea pig?

Veterinary Reference(Required)

If you currently own animals, please list your veterinary reference where vaccination records can be found, veterinary phone number, and whose name they are under. Please contact your veterinarian and give them permission to release your records so that we may finish your pre-adoption form. Then let us know when we can call them.

What is your small animal ownership experience?(Required)

What is your small animal ownership experience?

How experienced do you feel you are as a small-pet owner?(Required)

How experienced do you feel you are as a small-pet owner?

What requirements must this rabbit/hedgehog/guinea pig have?(Required)

What requirements must this rabbit/hedgehog/guinea pig have?

Additional Comments(Required)

Anything else you would like us to know?

I give the Northwoods Humane Society permission to confirm any information provided in this application that they deem necessary. This information will be held in confidence and used only for the purpose of adoption.

SIGNATURE(Required)

SIGNATURE

Date(Required)

DATE

Challenge(Required)

Please type RABBIT to prove you are human:

CAPTCHA