APPLICANTS INFORMATION:

Full Name:_______________________________________ Age:________

Address:_______________________________________
City:_______________________________________ State: ____ ZIP: __________
Email:_____________________________
Phone: (H) ________________________ (C) ________________________

CURRENT EMPLOYER:
Name: ______________________________________________
Phone: ______________________________________________
PLEASE GIVE TWO PERSONAL REFERENCES OF PEOPLE WHO KNOW YOU WELL
(Name, Address and Phone):

1.______________________________________________________________________________
2.___________________________________________________________________________________

What is your reason for wanting to adopt pet rats specifically?

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Do you belong to any rat clubs/forums? If so, which ones?

___________________________________________________________________
Are you willing to maintain communication (at least once a month for the next 3 months) with text
and picture updates of Dawson?
___________________________________________________________________

HOUSEHOLD INFORMATION:
Do you live in a (circle/underline one):

House

Do you (circle/underline one)

Apartment
Own

Rent

REQUIRED: If you rent, please submit a copy of the page of your lease which states that PETS ARE

ALLOWED. If you cannot find the lease, please give us the name and number of your
landlord:
______________________________________
If you move in the future, what will you do with your rats?
__________________________________________________________________________
Are all members of your household aware of your plans to adopt a rat (circle/underline
one)? YES
NO
# of adults: _____ # and ages of children_______________________
Have you ever rowned a rat before? (Circle/underline one)

YES

NO

Do you currently own any rats? (If so, please specify if they are males/females, and if they are
neutered/spayed) ________________________
Who will be the primary caretaker of the rats?________________________
What cage will be used to house the rats? ________________________
What are the dimensions? _____x_____x_____
Will you be willing to submit a picture of the cage? (Circle/underline one)

YES

NO

Rats need plenty of hiding places in their cage and hammocks and toys are very good as well.
Rats also need lots of supervised outside of the cage playtime with you every day.
Are you prepared to provide the rats with hiding places, hammocks, toys and outside of the cage
playtime every day? (Circle/underline one)
YES
NO
How much time per day can you dedicate to the rats?
__________________________________________________________________________
What do you plan to feed your rats?
__________________________________________________________________________

What bedding or litter do you plan to use in the cage?

__________________________________________________________________________
Where do you buy your pet supplies?
__________________________________________________________________________
What will you do with your rats when you go on vacation?
__________________________________________________________________________
Have you ever deliberately bred rats before, and for what purpose?
__________________________________________________________________________

Have you or anyone in your household ever been convicted of animal abuse, neglect or
cruelty? (Circle/underline one) YES
NO
Do you or anyone in your household own a snake or reptile? ___________________
Do you or anyone in your household own dogs? If so, what breeds?
_________________________________________
When rats become ill, they can require costly veterinary care. Are you willing and financially able to
provide your rats with the care they may need?
(Circle/underline one) YES

NO

Does anyone in the household smoke?

Is anyone in your household allergic to rodents?

(Circle/underline one) YES

NO

(Circle/underline one) YES

NO

PET HISTORY:
Please provide contact information for the veterinarian you are currently seeing or plan to see:
Name of Clinic:

________________________________________

Name of Veterinarian: ________________________________________

Address:

________________________________________

Phone Number:

________________________________ (REQUIRED)

Please list all of the animals by name which have been part of your family during the last 5 years (if
you need more room, please continue the list on the back or in another email. Please include reptiles
and birds as well as mammals.
Indicate the status of each using the codes below:
0=Still with me

1= Died

2= Placed in another home

3= Lost/ran away

4= Stolen

5= Turned into shelter

6= Euthanized

7= Sold
Spayed/

Pets Name

Species/Breed

Gender

Neutered?

Status

1 _________________________ _____________________________

M F

Y N

___

2 _________________________ _____________________________

M F

Y N

___

3 _________________________ _____________________________

M F

Y N

___

4 _________________________ _____________________________

M F

Y N

___

5 _________________________ _____________________________

M F

Y N

___

(if you need more room please continue on the back of the form)

I hereby certify that I have read and understand all the questions on this form. All information
supplied by me on this application is true and understand if I am selected to adopt the rat, this
application becomes part of my adoption contract.

Signature:_________________________________

Date: _________________