Animal(s) you are
applying for:
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Your name: |
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Address (include city& zip):
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Telephone
(work and home), include area
code: |
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Email address: | |
Name and Phone Number of
person who can always reach you who does not live at the above
address: |
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Where do you live? |
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Do you (select all that apply) :
| Own
Rent, Live w/roommates
Rent,
live alone Living
w/parentsStudent
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How long have you lived at
this address? | |
List all human members of household
and ages of children: | |
Does any member
of your household have any known allergies to animals? |
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If yes, please describe: | |
Do we have permission to visit your home? | |
If no, why not?
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Pet History | |
Do you currently have any other pets? |
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If yes, please describe (include all animals including roommates' animals), type,
age, sex, spayed/neutered, kept indoors or outdoors, had how long? |
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Your veterinarian's name and
telephone number:
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Is your veterinarian experienced in treating exotic
pets? |
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List pets owned in the past 10 years, other than those listed above. Include type, age, sex, spayed/neutered, kept indoors
or outdoors, had how long, when you stopped owning the animals and reason: |
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Have you ever
lost a pet? What did you do to find him/her? |
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Have you ever brought an animal to the shelter?
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If yes, what were the circumstances? | |
Do you
anticipate moving soon? | |
If yes, when? |
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Small Animal-Specific
Questions |
Please state reason for wanting a small animal as a companion: | |
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Where will you keep your small
animal when you're not home? |
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How much time per day will you
be able to interact with your small animal? | |
If you suddenly
relocated or had other drastic lifestyle changes that made it hard to keep
your small animal, what would you do with him/her? |
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Who will care for your small
animal when you go out of town, or in case of an
emergency? |
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If your small animal becomes seriously
ill or injured and your veterinarian says expensive medical treatment is
needed, what will you do?
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(Rabbits and Chinchillas Only) Do you plan to
have your rabbit spayed or neutered? Why or why
not? |
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To provide food
and medical care for this small animal, I anticipate spending
yearly: |
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In terms of training and care, do you thing a
small animal will
require more, less, or about the same amount of time and
effort as a cat? |
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Since small animals tend
to chew, how will you protect your home? |
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Will your small animal be
caged? Size of cage? Material
cage constructed of? |
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Will cage be kept
indoors? Which room? |
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If outdoors,
where will cage be in relation to the house, and where in relation to
shade and shelter from wind and rain? |
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How much time will the small
animal be uncaged? Indoors and/or outdoors? |
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How many hours per day will your
small animal spend alone? |
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Where will the small animal sleep at night? |
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What kind of diet will you provide for your
small animal?
What brand of pellets, what kind of hay, which vegetables,
what kind of treats? |
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Are you committed to taking
full responsibility for your small animal's health and welfare for the rest of
its life, which could be 10 years or more? |
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I certify that I am 18 years of age or older
and that I live within driving distance of Austin, Texas. Please click
Submit when you are done.
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