Name
              
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                    First Name 
                   
                
                
                  
                     
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email
              
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              Phone
              
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                    (###) 
                   
                
                
                  
                     
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              Address
              
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                    Address 1 
                   
                
                
                  
                     
                    Address 2 
                   
                
                
                  
                     
                    City 
                   
                
                
                  
                     
                    State/Province 
                   
                
                
                  
                     
                    Zip/Postal Code 
                   
                
                
                  
                     
                    Country 
                   
                
               
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Name of ALTERNATE Contact
              
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                Can be a close family member, significant other, or close friend who could get  ahold of you if we can't
                
                  
                     
                    First Name 
                   
                
                
                  
                     
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Alternate Contact's Phone
              
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                    (###) 
                   
                
                
                  
                     
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              Please list all members of your household and their ages
              
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              Do any members of your household have allergies to animals or hay?
              
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              Do you own or rent your home? If renting, please enter your landlord's contact information
              
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              Which rabbit(s) are you interested in? 
              
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              Have you owned a house rabbit before?
              
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                  Yes
                
                  No
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Do you currently own a house rabbit? 
              
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                  Yes
                
                  No
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              If yes, are they spayed/neutered? 
              
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                  Yes
                
                  No
                
                  N/A
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              If you currently have a rabbit, please tell us about their care, including litter box management, and living space.
              
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              Have you ever dealt with G.I. stasis in a rabbit? Do you know how to recognize the symptoms?
              
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              Please list all animals currently in your household, if they are spayed/neutered, and where they are kept
              
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              If you have other animals in your home, do they have access to your rabbit’s living space?
              
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              Do we have permission to contact your vet for a referral?
              
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                  Yes
                
                  No
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              How much money would you be willing to spend on your rabbit in the case of a medical emergency (post-adoption)? 
              
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              Are you willing to take your rabbit to the vet for an annual check up?
              
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                  Yes
                
                  No
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              What will you do if you can no longer care for your rabbit?
              
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              If your application is approved, do you agree to send photos of your potential rabbit’s living space or consent to a home check? 
              
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                  Yes
                
                  No
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I will care for the animal in the most humane manner.
              
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                  I agree
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              The animal will be kept in my home until adopted or returned to rescue.
              
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                  I agree
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I will promptly notify the rescue if the rabbit has any suspected ailment, injury, or illness
              
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                Vet visits not approved by a rescue official will not be allowed or reimbursed
                
                  I agree
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I will follow medical advice and treatment plan given to me by the rescue and the veterinarian selected by True Hearts for Healing Paws
              
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                  I agree
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I will not abandon, sell, give away, dispose of, turn over to, or relinquish custody or possession of the rabbit except to return the animal to the rescue.
              
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                  I agree
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I will return the rabbit promptly to the rescue if I do not wish to continue to foster the rabbit or abide by all terms of the contract. 
              
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                  I agree
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              I understand that I do not have permanent ownership rights of this rabbit until the official adoption contract has been signed.
              
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                  I agree