Owner Surrender and Relinquishment Form - Ohio House Rabbit Rescue

Please help us provide great care for this animal by thoroughly completing the following information. Thank You!

Owner Name: *

Date:

Address:

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Phone: *

Alternate Phone:

Email: *

Rabbit's Name:

Reason for Surrender:

How did you hear about Ohio House Rabbit Rescue?

Other Description:

I originally got my rabbit from:

I've owned him/her for:

My rabbits age (if known):

My rabbit's enclosure is:

Other Description:

My rabbit spends this much time outside of his/her enclosure daily:

My rabbit has lived with:

Other RabbitsDogsCatsOther

Other Description

When my rabbit is around other rabbits, they usually:

Snuggle & PlayFightIgnore Each Other

My rabbit usually behaves in the following way around:

Cats

FriendlyShyIndifferentAggressiveUnknown

Dogs

FriendlyShyIndifferentAggressiveUnknown

Children

FriendlyShyIndifferentAggressiveUnknown

Strangers

FriendlyShyIndifferentAggressiveUnknown

My rabbit has a litter box in his/her living space:

YesNo

If yes, how often does he/she use the litter box?

AlwaysSometimesNever

My rabbit uses this type of litter:

My rabbit usually eats (check all that apply)

HayGreen VegetablesCarrots and/or fruitTreatsPelletsOther

Other Description:

My rabbit was last seeen by a veterinarian on (Date):

at (Vet Practice Name/Vet's Name):

My rabbit is already spayed or neutered:

YesNo

If yes, at which veterinary clinic was the surgery performed?

My rabbit has the following health concerns:

Other helpful information about my rabbit:

Please review and sign below acknowledging the following: - I am the owner of this rabbit or the owner's representative acting upon the owner's consent.

- I have been offered support and information to help me keep my rabbit but decline it at this time.

- 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.

- Rabbits with unmanageable illness or contagious disease and rabbits that pose a health or safety risk to people or other animals and cannot be handled safely may not be candidates for our adoption program and may be humanely euthanized. Ohio House Rabbit Rescue, Inc. cannot guarantee adoption or placement of any rabbit. Sometimes health, age, or behavioral problems become evident after admission or our veterinarian/staff discover them upon examination or evaluation.

- 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 *

Owner Surrender and Relinquishment

Surrender Rabbit Profile

Verification