RABBIT SURRENDER REQUEST FORM

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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

* GenderMaleFemale

Country

*State/Province

Date of Birth

* Month

* Day

* Year

RABBIT PROFILE

Rabbit breedŵ

Rabbit size

RABBIT'S NAME

Rabbit breed

RABBIT'S APPROXIMATE AGE OR DOB

IS THIS RABBIT SPAYED OR NEUTERED?

YesNo

GENDER?

MALEFEMALE

HOW LONG HAVE YOU HAD THIS RABBIT?

WHERE DID YOU ORIGINALLY OBTAIN THIS RABBIT?

Blue Chip Rabbitat Breeder or FarmPet ShopFriend/RelativeFound/Stray Other Rescue/ShelterOther

IF FROM ANOTHER RESCUE/SHELTER, PLEASE PROVIDE THE FACILITIES INFORMATION. IF FOUND AS A STRAY, PLEASE PROVIDE LOCATION.

HAS THIS RABBIT HAD ANY OWNER OTHER THAN YOURSELF? IF SO, HOW MANY? PLEASE LIST TIME FRAMES AND THEIR REASON FOR REHOMING, IF KNOWN.

WHY DO YOU NEED TO SURRENDER THIS RABBIT? PLEASE PROVIDE SURRENDER REASON WITH AS MUCH DETAIL AS POSSIBLE.

Rabbits breed

Ex- mini lop, Netherland dwarf, flemish giant, Dutch,

RABBIT DETAILS

Help us understand your rabbit

what size is your rabbit?

Temperment of you rabbit?

THIS RABBIT IS USED TO LIVING:

INSIDEOUTSIDEBOTH

DOES THIS RABBIT HAVE A FAVORITE ITEM, TOY, GAME, ETC?

WHAT LEVEL OF HUMAN CONTACT DOES THE RABBIT ENJOY?

FOR INSTANCE, DOES THIS RABBIT ACCEPT BEING HELD? LIKE TO SIT ON YOUR LAP? JUMP UP ON THE SOFA NEXT TO YOU? PREFER TO STAY ON THE GROUND?

HOW MUCH TIME DOES THIS RABBIT SPEND OUTSIDE OF HIS/HER CAGE/SPACE?

HAS THIS RABBIT EVER BEEN AROUND OR HANDLED BY CHILDREN?

YesNo

HAS THIS RABBIT EVER BITTEN SOMEONE?

HAS THIS RABBIT EVER BEEN EXPOSED TO OTHER ANIMALS? IF SO, PLEASE LIST EACH TYPE AND HOW THE RABBIT REACTS TO THEM.

IS THIS RABBIT LITTER BOX TRAINED?

YesNo

FEEDING INFORMATION

DOES THIS RABBIT EAT HAY DAILY?

YesNo

IF ANSWERED YES, WHAT KIND OF HAY HAS BEEN PROVIDED?

THIS RABBIT IS ACCUSTOMED TO DRINKING FROM A:

BOWL WATER BOTTLEBOTH

IS THIS RABBIT OFFERED ANY GREENS, VEGETABLES, HERBS OR FRUIT ON A REGULAR BASIS? IF YES, PLEASE LIST WHAT KIND AND HOW OFTEN.

IS THIS RABBIT OFFERED FOOD PELLETS? IF SO, WHAT BRAND AND FORMULA?

*Please send a small amount with the rabbit(s) for transition, if possible.

IF SO, HOW MUCH PER DAY?

IS THIS RABBIT OFFERED TREATS? WHAT TYPE? HOW OFTEN? ANY FAVORITES?

ARE THERE ANY OTHER DETAILS OR SPECIAL CONSIDERATIONS WE SHOULD KNOW ABOUT?

HEALTH HISTORY

DOES THIS RABBIT HAVE ANY HEALTH PROBLEM THAT YOU ARE AWARE OF?

YesNo

IF YES, PLEASE LIST MEDICAL CONDITIONS

IS THIS RABBIT ON ANY CURRENT MEDICATION, SUPPLEMENTS OR A SPECIAL DIET?

YesNo

IF YES, PLEASE LIST WHAT THIS RABBIT IS CURRENTLY ON

PLEASE LIST ANY CONCERNS THAT YOU HAVE REGARDING THIS RABBIT

WE ARE VOLUNTEER BASED. IF YOU DO NOT RECEIVE A RESPONSE WITHIN 10-14 DAYS, PLEASE CALL US AT 570-333-5265 OR MESSAGE THE BLUE CHIP RABBITAT FACEBOOK PAGE. PLEASE NOTE THAT WE CAN NOT ACCEPT ALL SURRENDERS.

Blue Chip Rabbitat cares deeply for all the rabbits that pass through our doors. We ask, if/as possible, for a surrender fee donation of $50 to help towards the cost of spay/neuter, vaccines, wellness vet check plus their needs and care prior to adoption. This is not mandatory but greatly needed. Though any amount helps us to be able to help them along their journey to their new FURever home.

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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