First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Alt Email

Birth Date:*

Preferred method of contact?

If employed please list employer, position and number of years with the company.*

Number of adults in home*

Please list the name, birthdate, and employer of each adult in the home*

Number of children in the Home. (part time & full time) Please list ages*

Please list the age of each child in the home

Does anyone in your household have allergies?

How often do you travel for business or pleasure?*

How many years have you lived at your current address?*

Do you live in a

Do you own your home?

Please list your landlord, home owners association contact, or property manager. Include name and phone number.*

Does your landlord or association have a restriction on the number of pets?

Do you currently have other animals in your home?

Please list all of the pets you currently own- list name, breed, and age*

Please list the NAME and PHONE NUMBER of your current veterinarian. For animals that have passed away, please list the veterinarian they were seen by. We will confirm all your pets vaccinations with your vet. If you use multiple veterinarians please list them all. *

May we call to confirm your pet's medical history, vaccination status and spay/neuter? *Application will be denied without approval to talk to your veterinarian. *All animals in your home must be spayed/neutered and up to date on vaccinations for your application to be approved.

Are your current pets spayed or neutered?

Are your current pets up to date on vaccinations?

Are you willing to go to the time and expense of obtaining emergency veterinary care?

Are there any pets that you have had in the past that have passed away or that have been re-homed?*
Choose one: Yes No

If yes please explain.

Have you ever adopted from a rescue or shelter before?

What animal are you interested in adopting?
Choose an animal: Athena Atlas Audrey Bear Billie Bo Bongo Boo Braizin Broly Butters Caramel Champ Charlie Chase Chase Clancy Clark Diesel Dixie DJ Dodger Duke/Jock Ellen Felon Garnett (must be adopted with Onyx) Goose Gravy Grayson Greta Griz Herkie Hippo Isabel Jack Jax Jazzy Jean Jeffry Jerry Jerzy Jessa Juliette Jupiter Kaia Carson Khloe King James Kirby Laekyn Leonardo and Michelangelo Liam Lily Louie Lucky Lucy Luna (must be adopted with Ricky and Ricky) Maisleigh Mama Rosemary Mario Matilda and Trixie Max Mocha Naiah Nevaeh Noodle Nyx Onyx (must be adopted with Garnett) Oscar Otis Palmer Porkchop Porter Prince Quinn Radio Ricky (must be adopted with Luna and Luna) Romeo Roo Rosalee Ruckus Rusty Ryker Sarge in Charge Siren Soot Sophia Sparkle Spot Star #2 Starr Steele Stevie Tallulah Thin Mint Thor Tiger Tink Trigg Trixie Velma Victoria Watson IC Whiskey William Wonder Boy

Why are you interested in this particular animal?*

If the animal you are interested in was not listed above, please provide the name here.

Are you open to meeting animals if this animal is no longer available or doesn't meet your expectations?

Why do you want a rabbit as a companion? *

Have you had a rabbit before? *

What resources have you used to prepare for a rabbit?

Are there any characteristics that you would prefer in a bunny?

Please describe your rabbit housing.

How much play time will the rabbit receive in a day?*

How much time with people will the rabbit receive a day? *

What will you do with your pet when you’re traveling?*

What would cause you to give up or re-home your rabbit? *

How did you hear about us or this animal? *

References must be 21 years of age or older. Please only use 1 family member and do not include references that share the same address or live with you. Please notify your references that if you choose to adopt with Last Hope, we will be contacting them. It could delay the process if they do not return our calls/emails.

#1 References Name*

#1 References Phone Number*

#2 Reference Name*

#2 References Phone *

#3 References Name*

#3 References Phone*

I certify that the information that I have given is true and I authorize investigation of all statements made above. I recognize that any misrepresentation of facts may result in losing the privilege of adopting a pet. I understand that Last Hope Animal Rescue has the right to refuse any request for adoption for any reason. I authorize Last Hope Animal Rescue to investigate all statements in this application and to call my veterinarian and all listed references. I understand that a home visit will be required before my application to adopt will be approved. Initial to indicate you have read and understand these statements *

Signature*

Date*