Form

Full Name:*

E Mail Address:*

City & State:*

Are you 18 Years Old?*

Yes No

First Names and Ages of All Household Members:*

Do you Own or Rent?*

Own Rent

Landlord's Name and Number:

Which Rat(s) are you interested in adopting?

If no specific rat in mind, what are you looking for in a rat?

List any user names you use on cummunity sites such as GooseMoose, RatForum, MySpace, etc.*

Please list all of your current pets with species, age, sex, and if they are spayed or neutered.*

Have you ever surrendered an animal to a shelter, resuce, pound etc?*

Yes No

If yes please explain:

Please list the pets you have had in the past 5 years but no longer have and why:*

Who is your Vet? Please include clinic name, doctor's name and phone number.*

What type of Food will you be feeding? Please be spedific including brand names.*

What Type of Bedding will you be Using? Please be specific including brand names.*

What Cage will you be using? Be specific including brand name, dimmensions, and a photo would be ideal.*

How many Rats Will be Kept In This Cage?*

How much out of cage time will your rats get and where?*

Do you currently breed or have you ever bred any animals? If yes please explain.*

Do any household members smoke inside your home?*

Yes No

Remarks: