First Name: Last Name: Year of Birth:
Address: City: Province: Postal Code:
Daytime Phone: Evening Phone: Email Address:


1. Do you currently: Rent Own       Other:
2. If renting, does your agreement permit the keeping of pets? Please note that New Moon Rabbit Rescue may request a signed letter from your landlord.Yes No
3a. How many adults live in your household?
3b. How many children and what are their ages?
4. Who will be the primary caregiver of this rabbit?
5a. Does anyone in the household have allergies to pets or hay? YesNo
5b. If so, what type of allergies?
6a. Do you plan on using this rabbit as a classroom rabbit, demonstration, as part of a magician's act, etc.?YesNo
6b. If so, please explain.


7a. Have you ever surrendered, sold or given away a pet? Yes No
7b. If so, what type of animal, how long ago and what were the circumstances?
8. Do you currently have any other pets?YesNo
9. If so, please list with type, breed, age and indicate whether or not each pet is altered.
10. Do you anticipate any difficulties with your other pets accepting a rabbit?YesNo
11. If there are any problems, how will you overcome these difficulties?


12a. Do you have a rabbit savvy veterinarian?YesNo

12b. Clinic: Phone: Veterinarian(s):
13. Do you plan on yearly check-ups?Yes No
14. Health issues in a rabbit can arise suddenly and without warning. They will require immediate medical attention. Because of this, emergency trips to the vet can sometimes become costly. Are you prepared to deal with this if the situation occurs?Yes No


15. Will this be your first rabbit? Yes No

If this is your first rabbit, please skip to question 24.

16. If this is not your first rabbit, do you still own this/these rabbit(s)? YesNo
17. What are the circumstances under which you no longer have this/these rabbit(s)?
18. Does your current rabbit(s) have any medical conditions? Yes No


19. Do you plan to bond your existing rabbit to your new rabbit? Yes No

If no bonding is planned, please skip to question 24.

20. Is your current rabbit spayed or neutered?Yes No
21. Do you plan on spaying or neutering your current rabbit(s) before any introductions take place? Please note that introductions should not take place immediately following surgery, as recovery time is necessary.Yes No
22. Have you bonded rabbits before?Yes No
23. What methods do you plan to use for bonding?
24. If bonding is unsuccessful, what would be your plans in dealing with this issue?


25. Where will your new rabbit be housed? Please note that New Moon Rabbit Rescue may request to see photographs of the rabbit's cage/enclosure and/or living space. Please check all that apply.

IndoorsFree-RoamingCagedOutdoorsPartially Free-RoamingOther

26. In what living space will your rabbit be housed (e.g. kitchen, living room, basement, bedroom, garage, etc.)?
27. If your rabbit is to be caged or partially caged, what are the dimensions and type of cage that you currently have or that you will be using?
28. Please provide details as to how you will be/have been rabbit-proofing your house or apartment.
29. If your rabbit is to be only partially free-roaming, how much time out of the cage/play time/socialization do you anticipate per day?
30. What type of food will you be feeding and what will your rabbit's diet be like?
31. New Moon Rabbit Rescue spays or neuters all rabbits that come into its care. This eliminates many undesirable behaviours such as digging, chewing and spraying. However, some rabbits may still exhibit behaviours that are unacceptable to the owner. How do you intend to deal with these issues should they arise?
32. What do you plan to do with your rabbit if you go on holiday?
33. What do you plan to do with your rabbit if the circumstances of your life change (new baby, a move, marriage, loss of employment, etc.)?
34. Rate your knowledge of rabbit care, 1 being little to none and 5 being very experienced:

1 2 3 4 5

35. Are you interested in a particular rabbit at New Moon Rabbit Rescue? If so, please provide his/her name.
36. Additional comments: