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Small Animal Adoption Questionnaire

Please fill out this questionnaire to the best of your ability.

Date *

// (mm/dd/yyyy)

First Name *

Last Name *

Street Address *

Suite / Apt #

City *

State *

Zip *

Email *

Phone *

Describe in detail the small animal you are looking for:

Have they been spayed or neutered?:

Yes
No
Unknown

Are they current on vaccinations?:

Yes
No
Unknown

If you have pets, will they adjust to a new animal in the house? Please explain:

How many people are living in your household? What are their ages?:

Does any member of your household have an allergy to animals?:

Where do you live?:

House
Apartment
Condominium
Mobile Home
Other

Do you own or rent your home?:

Own
Rent

Does your current veterinarian treat small animals?:

What type of enclosure are you planning to use for your small animal? Where will it be located?:

Are you aware that small animals such as hamsters can live up to 8 years; guinia pigs can live up to 10 years; and rabbits can live 10 - 15 years?:

Additional questions/comments:

I certify that the above information is true. I also understand that giving false information on this application is grounds for denying an adoption. *

Yes

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Small Animal Adoption Questionnaire