Clover Patch Sanctuary
Franklin Tennessee
Adoption Form
Adopting:____________________________________________________________
Date:_______________________________________________________________
Full Name:___________________________________________________________
Home Phone Number:__________________________________________________
Work Number:________________________________________________________
Cellular Number:_______________________________________________________
Address:______________________________________________________________
Email Address:_________________________________________________________
Birthday:______________________________________________________________
Drivers License #_______________________________________________________
State of License:________________________________________________________
Reference:_____________________________________________________________
Reference phone number:_____________________________________________
Number of animals currently in the home:_______
List names/ages/breed/type of animals currently in the home:
1.____________________________________________________________________
2._____________________________________________________________________
3.______________________________________________________________________
*If more than 3 continue listing on back of adoption form*
How will you keep current animals in the home from harming/hurting your rabbit?
Have you ever had a rabbit(s) as a pet before? Yes / No (circle one)
If you answered “Yes” please explain why the rabbit(s) are no longer with you.
Who will be the primary caregiver of the rabbit(s)?______________________________
*Please note: Persons under the age of 16 cannot be considered as primary*
What room of the home will your rabbit(s) live in?_______________________________
Do you own or have ever own snakes or other reptiles?___________________________
Do you intend on feeding this rabbit to a snake?________________________________
Have you ever bred rabbits or other animals?___________________________________
If so, when?_____________________________________________________________
Are you buying this rabbit(s) as a gift?________________________________________
If so, for whom?__________________________________________________________
Please list the names and ages of other persons living in the home:
1.______________________________________________________________________
2.______________________________________________________________________
3.______________________________________________________________________
4.______________________________________________________________________
5.______________________________________________________________________
Do you (Please circle one):
Rent
Own
Rent to Own
Live with family/friends
If you rent, please provide your landlord’s name and number:
If you live with family/friends, please provide the PRIMARY owner of the home’s name &
number:
Is your home 1 story or 2 story?_____________________________________________
Name & number of the veterinarian you intend to take your rabbit(s) to:
Does your veterinarian have experience with rabbits?
Are you agreeable to periodic home visits and/or phone calls by a member of our staff
to check on the welfare of your rabbit(s)?
Do you agree that if you move from your current address or out-of-state that you will
notify a member of Clover Patch Sanctuary of your new address and phone
number?__________________
Do you agree to contact a member of Clover Patch Sanctuary if your rabbit(s) dies?____
Do you agree to contact ONLY Clover Patch Sanctuary if you wish to surrender your
rabbit(s) and ONLY surrender your rabbit(s) to Clover Patch Sanctuary?__________
Do you understand that ALL of the rabbits in our care are “fur babies” to us
and we’ve promised them that we will ONLY place them in worthy and
deserving homes that will love them and cherish them as we do. We have
promised them that they will NEVER be novelties, never be impulse buys,
never eaten or abused by the residents of their forever homes AND they will
always be treated as valuable members of their forever family given the
SAME respect as given to dogs and/or cats? Please Sign below.
Clover Patch Sanctuary
Franklin Tennessee
Agreement/Contract
Please initial by the statements below if you agree:
_____I agree to treat this rabbit(s) I’ve adopted as a member of my family with all the
rights and privileges that I would give to dogs/cats.
_____I agree that I nor any other person(s) will punish this rabbit(s) with corporeal
punishments, spankings, deprivation of food/water or isolation or ANY punishment since
that is cruel and I will ONLY use positive reinforcement with my rabbit(s).
_____I am aware that I will spend $25-$30 per month on my rabbit(s).
_____I agree to take my rabbit(s) to a qualified veterinarian once a year for an annual
check up even if my rabbit(s) seem perfectly healthy.
_____I am willing to hire a pet sitter if/when I travel and I will NEVER leave my
rabbit(s) unattended during a vacation or trip.
_____I WILL seek medical attention for my rabbit(s) with a qualified veterinarian if my
rabbit(s) becomes ill.
_____I will provide proper grooming for my rabbit(s) including but not limited to
brushing, nail trims and regular checkups for over growth of my rabbit(s) teeth.
_____I WILL house my rabbit(s) indoors in an appropriate playpen or cage habitat
approved by Clover Patch Sanctuary.
_____I agree that I will NEVER house my rabbit(s) outdoors for ANY REASON and that
my rabbit(s) will only be outside for fresh air & play time during short intervals & ONLY
when supervised by an adult or responsible party over the age of 16.
_____I understand that Clover Patch Sanctuary is not responsible for my rabbit(s)
medical care cost.
_____I WILL clean my rabbit(s) litter box & habitat daily never filling it with cat litter or
any litter unsuitable for rabbits.
_____I agree that I will feed my rabbit(s) unlimited amounts of grass hay as this
promotes good health to my rabbit(s).
_____I will strive to make my rabbit(s) my companion and incorporate it into my home
just as I would a dog or cat.
_____I agree that I will ONLY pick up my rabbit(s) in the appropriate way as explained
and demonstrated by Clover Patch Sanctuary and I will never restrain my rabbit(s) in
any way.
_____I understand FULLY that rabbits are fragile creatures and MUST be handled
carefully and respectfully, therefore I will always supervise my rabbit(s) when in the
company of small children.
_____I agree to return this rabbit(s) to Clover Patch Sanctuary if for ANY REASON I can
no longer care for it.
_____I acknowledge that NO refunds are given on returned rabbits but Clover Patch
Sanctuary will accept my rabbit(s) ALWAYS and will find it a loving home.
_____I will allow Clover Patch Sanctuary to reclaim this rabbit(s) if they deem that any
of the above conditions have not been met.
Full Name of Applicant:
Date:
The above signed contract recognizes the right of Clover Patch Sanctuary to refuse ANY
application for any reason and the applicant will not hold Clover Patch Sanctuary
responsible for any liabilities involved with the adoption or ownership of any animal.