Good Samaritan Rescue/Surrender & Relinquishment Please help us provide great care for this animal by thoroughly completing the following information. Thank you!Rescuer's Name: *Date Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryHome Phone *Cell Phone Email *How did you hear about Ohio House Rabbit Rescue: Word of MouthWebsiteNewspaperTelevisionRadioOtherOther Description: Where and under what conditions did you find the rabbit? If you have had the rabbit in your possession for any period of time, please let us know anything you observed about the following: Eating habits (what foods, how often) Behavior (friendly, aggressive, biting, etc) Litter Box Habits (using litter box?) Any Health Concerns Did you take the rabbit to a veterinarian? Why and what were the outcomes? Anything else that would be helpful for us to know: Please review and sign below acknowledging the following: - I am a Good Samaritan who rescued this rabbit. I do not know who the rabbit's owner is. - I understand that I will be charged a non-refundable donation of $40/$60 to admit this rabbit to Ohio House Rabbit Rescue, Inc. - I understand that Ohio House Rabbit Rescue, Inc. is a nonprofit organization whose mission is to build and operate a Center for rescued abandoned pet rabbits, offer a robust adoption program, and provide educational resources and programming on the proper care of rabbits as indoor companions. - I understand that Ohio House Rabbit Rescue, Inc. is a nonprofit organization whose mission is to build and operate a Center for rescued abandoned pet rabbits, offer a robust adoption program, and provide educational resources and programming on the proper care of rabbits as indoor companions. - I understand that whether or not this rabbit is made available for adoption is at the discretion of Ohio House Rabbit Rescue, Inc. and if I have questions regarding disposition of this rabbit, I should ask them now. - My signature below reflects that I have read and understand the above information and that I am releasing all rights and claims for this rabbit to Ohio House Rabbit Rescue, Inc.Signature *Date * VerificationPlease enter any two digits with no spaces (Example: 12) *This box is for spam protection - please leave it blank: