What is the name of the animal you are interested in adopting? Species*RabbitGuinea PigRat / MouseOtherFirst and Last Name* Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*Email* Why do you want to adopt this animal?* Have you cared for this type of animal before?* Yes No Please list all current companion animals in your household including species, sex, age, and how long they have been in your care.* Are your current companion animals spayed/neutered?* Yes No Please list the name and phone number of all veterinary clinics that have cared for your companion animals in the last 10 years.* May we contact these veterinarian clinics for a reference?* Yes No Do you work outside of the home?*YesNoStudentRetiredPlease describe the intended living space for this animal (cage type, size etc.)* Where will the intended living space for this animal be located? (e.g., family room, bedroom, outdoor pen, etc.)?* Do all the members of your household know and approve of this adoption?* Yes No Does anyone in the household suffer from asthma/allergies to animal fur/dander or hay?* Yes No I don't know If you move/travel, what will happen to this animal?* Are you 18 years or older?*If no, a parent/guardian will have to complete the adoption application Yes No Do you understand that children cannot be the primary caretaker for a small animal and that the daily care of the small animal must be under adult oversight? ** Yes No By submitting this application, I certify the information given is true, and I understand that Niagara Action for Animals reserves the right to deny my application for any reason at any time.* Agree Disagree