Rabbit Admissions Form

I hereby certify that I own, have assumed responsibility for or have no knowledge of any other owner of this animal prior to this admission. The information I have given Animal Friends, Inc. about this animal’s age, health and disposition is correct. I have truthfully acknowledged any dangerous behavioral characteristics and any past history of biting or aggressive behavior. If, in the sole opinion of Animal Friends, Inc., any of the above statements are incorrect or if the animal reacts negatively to the shelter environment, Animal Friends, Inc. may notify me to reclaim the animal.

I hereby surrender all my interest in this animal to Animal Friends, Inc. I request and understand that the decisions regarding this animal’s care while sheltered and placement into an appropriate home will be as Animal Friends, Inc. deems advisable. I understand that I have no recourse in these decisions, unless recommended or required by Animal Friends, Inc.

I understand that I must give Animal Friends 24 hours notice if I would like to reschedule my appointment to surrender my pet(s). As Animal Friends has many pets in queue to be admitted, I fully understand and agree that my place in line will be lost and my application purged if I fail to keep my appointment to surrender my pet(s). If, after this event, I would still like to surrender my animal(s), I agree to submit new paperwork for review and wait until a space once again becomes available.

Please acknowledge that you have read and agree to the above statement. I agree
Your Name 
Address 
City 
State 
Zip Code 
Phone Number 
Alternate Phone Number 
Email 
Date 
Rabbit's Name 
Age 
Gender Neutered Male
 Spayed Female
 Unaltered Male
 Unaltered Female
Breed 
Where did you get this rabbit? If Animal Friends, please call 412.847.8047. 
If from another shelter, what shelter? 
Have you contacted this shelter? Choice 1
 Choice 2
 Choice 3
How long has this rabbit been with you? 
Why are you surrendering this rabbit? 
Veterinarian's Name (if applicable) 
Veterinarian's Phone Number (if applicable) 
Has this rabbit had any reactions to medications? Yes
 No
 I don't know.
If yes, list reaction(s) here 
Has the rabbit had any of the following health issues? Fleas/Ticks
 Fur Mites
 Ear Mites
 Dental Problems
 Runny Eyes
 Sneezing/Discharge from Nose
 Digestive Issues
 Other
If "Other" please list here 
Describe the rabbit's personality Affectionate
 Aggressive
 Assertive
 Biter
 Calm
 Curious
 Confident
 Friendly
 Gentle
 Playful
 Mouthy
 Relaxed
 Scared
 Shy
 Submissive
 Squirmy
 Talker
 Timid
List the age(s) and gender(s) of people this rabbit has interacted with and describe their interactions. 
List species, weight, gender and age or animals the rabbit has lived with and describe their interactions. 
Please note any important interactions or traits. 
Favorite toys Digging in boxes
 Digging in litterbox
 Tossing toys
 Chewing
 Rearranging items
 Other
If "Other" please list here 
Describe the rabbit's diet Timothy hay
 Orchard hay
 Brome hay
 Alfalfa
 Timothy pellets
 Alfalfa pellets
 Alfalfa treats
 Greens, fruits, veggies specify below)
 I don't know
List any specific greens, fruits or veggies the rabbit prefers 
How does the rabbit prefer to drink water? Bottle
 Bowl
How much does the rabbit eat each day? 
How often and what times does the rabbit eat each day? 
What are the rabbit's current living arrangements? Cage (indoor)
 Exercise pen (indoor)
 Free roaming (indoor)
 Garage
 Hutch (outside)
 Running at large (outside)
Describe the rabbit's exercise time Supervised
 Unsupervised
How often does the rabbit exercise? 
Does the rabbit display territorial marking? Spraying
 Chinning
 Lunging
Is the rabbit litter trained? Yes
 No
If yes, what type of litter? 
Is the rabbit a chewer? If yes, what have they chewed? 
Under what circumstance(s) will the rabbit exhibit fear or biting? 
Other important notes? 

Rabbit Admission Form

Animal Friends

Caryl Gates Gluck Resource Center
562 Camp Horne Road | Pittsburgh, PA 15237
Phone: 412.847.7000 | Fax: 412.847.7001
speak@ThinkingOutsideTheCage.org
M-F 11 a.m.-7 p.m. | S/S 10 a.m.-5 p.m.

Copyright 2015 Animal Friends Inc.